Hauser R, Temple-Smith P D, Southwick G J, McFarlane J, de Kretser D M
Institute of Reproduction and Development, Monash University, Clayton, Victoria, Australia.
Hum Reprod. 1995 May;10(5):1152-5. doi: 10.1093/oxfordjournals.humrep.a136109.
A group of 16 infertile patients suspected of having a partial epididymal obstruction on the basis of severe oligozoospermia, normal-sized testes and a normal serum follicle-stimulating hormone, underwent scrotal exploration. Evidence of partial obstruction of the epididymis was found in 13 cases and of the vas deferens in one case, and was supported by finding normal spermatogenesis on testicular biopsy. Vasoepididymostomy or vasovasostomy were performed, resulting in a significant improvement of semen analysis in 50% of cases and in six pregnancies in two patients. The diagnosis of partial epididymal obstruction should be considered when the above criteria are met. If pregnancies do not result when intracytoplasmic sperm injection (ICSI) is used with the ejaculated spermatozoa, a testicular biopsy followed by a microsurgical by-pass procedure should be considered whenever normal spermatogenesis is diagnosed. In all cases, the epididymal spermatozoa should be aspirated during the operation and either used immediately for insemination or stored frozen. The remarkable results of the new artificial reproduction technologies and in particular ICSI, question the indication for microsurgical correction in cases of partial epididymal obstruction.
一组16名不育患者，因严重少精子症、睾丸大小正常且血清促卵泡激素水平正常而怀疑存在部分附睾梗阻，接受了阴囊探查。13例发现附睾存在部分梗阻证据，1例发现输精管存在部分梗阻证据，且睾丸活检显示生精功能正常，支持上述发现。进行了输精管附睾吻合术或输精管吻合术，50%的病例精液分析有显著改善，2例患者成功妊娠6次。当符合上述标准时，应考虑部分附睾梗阻的诊断。如果使用射出精子进行卵胞浆内单精子注射（ICSI）未成功妊娠，一旦诊断为生精功能正常，应考虑进行睾丸活检，随后进行显微外科旁路手术。在所有病例中，术中应抽吸附睾精子，要么立即用于授精，要么冷冻保存。新的人工生殖技术尤其是ICSI取得的显著成果，对部分附睾梗阻病例显微外科矫正的适应证提出了质疑。
