摘要
目的 探讨显微交叉吻合术治疗复杂性梗阻性无精子症的有效性和安全性。方法 选取2012年10月至2016年3月上海交通大学附属第一人民医院及上海交通大学医学院附属仁济医院行显微交叉吻合术治疗的复杂性梗阻性无精子症患者资料进行回顾性分析。共14例患者，其中10例行显微输精管交叉吻合术，术中探查发现：2例由于疝手术损伤造成一侧输精管缺损，伴另一侧睾丸萎缩或附睾梗阻；7例一侧输精管腹腔段梗阻，伴另一侧附睾梗阻；1例一侧输精管梗阻伴对侧睾丸萎缩。另外4例行显微输精管附睾交叉吻合术：3例一侧附睾头部梗阻伴对侧附睾尾部梗阻和输精管远端梗阻；1例一侧输精管阴囊段缺如，伴对侧睾丸萎缩。术后定期随访。结果 14例患者中2例失访，12例患者随访时间2-23个月，平均11个月。10例行显微交叉输精管吻合术后患者中（2例失访），1例尚未复查精液，6例输精管道复通，其中3例自然妊娠。4例行显微交叉输精管附睾吻合术患者中，2例输精管道复通，1例自然妊娠。术后均无明显不适和并发症发生。结论 根据术前严格评估和术中探查，复杂性梗阻性无精子症患者可行显微交叉吻合术，使难治性不育夫妇获得自然生育的机会，交叉显微吻合术为输精管道复通的有效途径之一。
Objective To evaluate the efficacy and safety of microsurgical crossover vasovasostomy in treating complicated obstructive azoospermia. Methods The data of 14 patients with complicated obstructive azoospermia treated with microsurgical crossover vasovasostomy were reviewed from October 2012 to March 2016. Ten of them underwent microsurgical crossover vasovasostomy. Intraoperative exploration revealed that 2 patients had vas deferens injury and contralateral testicular atrophy or epididymal obstruction due to previous hernia repair; 7 patients had obstruction of intracorporeal vas deferens on one side and epididymal obstruction on the other side; the other 1 patient had unilateral vasal obstruction with contralateral epididymal obstruction. Furthermore, 4 patients underwent microsurgical crossover vasoepididymostomy, including 3 patients who had obstruction at caput epididymis on one side, and obstruction at cauda epididymis and distal vas deferens on the other side; the other patient had absence of vas deferens in the scrotum on one side, and testicular atrophy on the other side. Regular follow-up visits were conducted after the surgery. Results Two patients were lost to follow-up; the other 12 patients were follow-up for an average of 11 （range： 2 -23 ） months. In the 10 cases receiving microsurgical crossover vasovasostomy （ including 2 patients lost to follow-up） , 1 has not undergone semen re-analysis, 6 were confirmed patent,including 3 reporting spontaneous pregnancy. The pateney rate in the 4 patients receiving microsurgical crosseover vasoepididymostomy was 2/4, with 1 patient reporting spontaneous pregnancy. There was no complaint of discomfort or complications following the surgery. Conclusions Mierosurgieal crossover anastomosis may be effective and safe for patients with complicated obstructive azoospermia, according to preoperative assessment and intraoperative exploration. It allows natural conception for patients with refractory infertility. The microsurgical crossover anastomosis could b
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第36期2868-2871,共4页
National Medical Journal of China
基金
上海市市级医院适宜技术项目（SHDC12014263）
