摘要
目的探讨显微外科输精管附睾吻合术治疗梗阻性无精子症的有效性,分析影响术后效果的因素。方法回顾性分析2013年9月至2018年9月在南京医科大学附属苏州医院行显微外科输精管附睾吻合术的42例患者的临床资料,术后观察复通、配偶妊娠等情况。结果42例患者中,共有36例完成吻合,6例因术中探查多段梗阻或腹腔段输精管梗阻未完成吻合。31例患者随访成功并纳入统计,随访时间共(22.77±7.95)月。23例患者复通,总复通率为74.19%(23/31),复通时间为术后(6.65±5.04)月。其中双侧吻合复通率高于单侧吻合复通,差异无统计学意义(P>0.05);术中附睾液可见活动精子的复通率高于未见活动精子的复通率,差异有统计学意义,(P<0.05);体尾部吻合患者术后复通率高于头部吻合复通率,差异有统计学意义,(P<0.05)。21位复通患者中,共有8位患者妻子自然妊娠,自然妊娠率为38.09%(8/21)。结论显微外科输精管附睾吻合术治疗梗阻性无精子症有较好疗效,术中附睾液可见活动精子、附睾体尾部吻合预示更高的手术复通率。
Objective To investigate the efficacy of microsurgical vasoepididymostomy in the treatment of obstructive azoospermia and further analyze the factors affecting the patency.Methods The clinical data of 42 patient who received microsurgical vasoepididymostomy in Suzhou Hospital of Nanjing Medical University from January 2013 until September2017 were retrospectively analyzed,and their patency,spouse pregnancy were followed up after operation.Results Of 42 patients,36 patients completed the operation,and 6 patients did not complete the operation due to multiple or intraperitoneal segment obstruction.31 patients completed the follow-up and follow-up time was 22.77±7.95 months.General patency rate accounted for 74.19%(23/31)and average patency time was 6.65±5.04 months after the operation.The patency rate of bilateral anastomosis was higher than that of unilateral anastomosis.The difference was not statistically significant(P>0.05).The rate of patency was increased when motile sperms were detected in flowing fluid,the difference was statistically significant(P<0.05).The patency rate of patients with caudal anastomosis was higher than that of head anastomosis,the difference was statistically significant(P<0.05).Among the 21 patent cases,8 patient spouse had a natural pregnancy,and the natural pregnancy rate was 38.09%(8/21).Conclusion Microsurgical vasoepididymostomy is effective for obstructive azoospermia.Caudal anastomosis and flowing fluid with motile sperm during the operation indicate a higher patency.
作者
余怡
李树根
吴光
樊彩斌
杨慎敏
孙健
Yu Yi;Li Shugen;Wu Guang;Fan Caibin;Yang Shenmin;Sun Jian(Department of Urology,The Affiliated Suzhou Hospital of Nanjing Medical University,Suzhou 215002,Jiangsu,China;Department ofAndrology,Center for Reproduction and Genetics,The Affiliated Suzhou Hospital ofNanjing Medical University)
出处
《中国男科学杂志》
CAS
CSCD
2019年第6期54-57,共4页
Chinese Journal of Andrology
基金
中华医学会生殖医学青年医师研究与发展项目（18010270756）
江苏省卫生健康委员会面上项目（H2018050）
苏州市男性生殖研究重点实验室项目(SZS201718)
苏州市科教兴卫青年科技项目(KJXW2017028)
作者简介
共同通讯作者:孙健,E-mail:18651111090@sina.cn;共同通讯作者:杨慎敏,E-mail:drim2004@126.com。
