摘要
目的探讨梗阻性无精子症患者初次输精管道显微吻合术失败后再次显微重建手术的有效性和安全性。方法本研究为回顾性病例系列研究, 分析了因初次显微镜下输精管道重建手术失败, 2015年3月至2020年6月期间于上海交通大学医学院附属第一人民医院泌尿外科临床医学中心男科行再次手术治疗的21例梗阻性无精子症患者的病例资料, 术后随访患者症状缓解或复通及妊娠情况。结果 21例患者中, 8例初次手术为输精管输精管吻合术, 8例为输精管附睾吻合术, 5例为交叉吻合术;2例因输精管结扎术后睾丸疼痛行手术治疗, 19例因生育需求行手术治疗。再次手术探查发现14例原吻合口狭窄, 6例吻合口有精子肉芽肿形成, 1例术中证实为非梗阻性无精子症。19例成功行单侧或双侧输精管道吻合术, 1例患者因原术区粘连严重而未能行再次吻合, 行睾丸取精术;1例术中证实为非梗阻性无精子症患者行睾丸显微取精术。术后随访(30.2±18.4)个月, 范围为3~58个月, 2例失访。术后随访显示, 输精管结扎后睾丸疼痛患者1例阴囊症状完全缓解, 1例部分缓解;术后11例再通成功, 4例自然妊娠, 2例患者尚未复查精液。3例患者通过辅助生殖技术成功妊娠(1例使用新鲜精液精子, 2例使用术中冻存睾丸精子)。所有患者术中、术后均未出现并发症。结论对于初次显微重建手术失败的梗阻性无精子症患者, 再次输精管道重建手术安全可靠, 可获得满意的术后复通率和自然妊娠率。
Objective To analyze the effectiveness and safety of reoperation for obstructive azoospermia(OA)with initial microsurgical anastomosis failure.Methods A retrospective case series was performed for OA patients who underwent reoperation after initial microsurgical anastomosis failure,in Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Institute of Urology,Urologic Medical Center from March 2015 to June 2020.Totally,21 patients were enrolled in the study,and the clinical data,patency and pregnancy outcomes were reviewed.Results During the initial surgery,8 cases underwent vasovasostomy and 8 cases underwent vasoepididymostomy,while the other 5 cases underwent crossover anastomosis;19 cases underwent reoperation because of reproductive needs,and 2 for post-vasectomy chronic testicular pain.During the reoperation,anastomotic stricture was found in 14 cases,and sperm granuloma was found in 6 cases,while spermatogenic dysfunction was confirmed in 1 case.Unilateral or bilateral anastomosis was performed successfully in 19 cases.Testicular sperm extraction was performed for 1 case with non-obstructive azoospermia(NOA)and 1 case with severe adhesion respectively.Totally 19 cases was followed for 3 to 58 months[(30.21±18.43)months],and 2 cases were lost to follow-up.Chronic testicular pain was relieved completely in 1 of the 2 cases suffering from the post-vasectomy testicular pain.Overall,11 cases achieved patency,and 4 cases concieved naturally.Furthermore,3 cases underwent in vitro fertilization cycle(1 case with semen sperm,and the other 2 cases with frozen testicular sperm).There were no severe post-operational complications in all cases.Conclusion Microsurgical reoperation,which allows a favorable patency rate and natural pregnancy rate,is a valid option for the treatment of OA with initial microsurgical anastomosis failure.
作者
赵晶鹏
李朋
陈慧兴
田汝辉
智二磊
黄煜华
姚晨成
李铮
Jingpeng Zhao;Peng Li;Chen Huixing;Tian Ruhui;Zhi Erlei;Huang Yuhua;Yao Chencheng;Li Zheng(Department of Andrology,Center for Men's Health,Institute of Urology,Urologic Medical Center,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200080,China;Shanghai General Hospital of Nanjing Medical University,Shanghai 200080,China)
出处
《中华生殖与避孕杂志》
CSCD
北大核心
2022年第4期394-398,共5页
Chinese Journal of Reproduction and Contraception
基金
国家重点研发计划(2017YFC1002003)
国家自然科学基金(81701524, 81671512)
上海“科技创新行动计划”项目(20Y11907600)
上海市科学技术委员会科研计划项目(17JC1420403)。
