输精管结扎术后患者行显微镜下输精管复通术的疗效  

Efficacy of microsurgical vasectomy reversal on patients after vasectomy

作　　者：彭靖[1] 袁亦铭[1] 宋卫东[1] 崔万寿[1] 张志超[1] 李俊杰[1] 高冰[1] 辛钟成[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿,男性生殖系肿瘤研究中心

出　　处：《北京大学学报（医学版）》2013年第4期597-599,共3页Journal of Peking University:Health Sciences

摘　　要：目的:了解显微镜下输精管复通术的效果。方法:2006年1月至2011年12月北京大学第一医院泌尿外科共收治输精管结扎术后要求复通的41例患者,患者平均年龄45(29～66)岁,平均结扎时间12年。术前至少2次精液常规检查未见精子,性激素水平正常。对这41例患者进行阴囊探查,如果附睾端输精管内可找见精子,行显微镜下输精管吻合术;如果附睾端输精管内无附睾液流出或挤出"牙膏样"分泌物则行显微镜下输精管附睾吻合术。术后3个月复查精液常规,精子密度>1×104个/mL证实为精道复通,随访至配偶怀孕。结果:41例患者随访3～72个月,5例失访。输精管结扎15年以下患者共有28例,其中3例失访;21例患者复查的精液中可见精子,精子密度为2×106～46×106/mL,活力0%～60%,6例患者配偶自然怀孕;4例患者术后反复查精液常规未见精子,其中2例随访12个月后仍无精子建议辅助生殖,另2例随访时间<12个月继续随访。输精管结扎15年及以上患者共有13例,其中2例失访;7例复通,1例其配偶怀孕;4例复通失败。结论:显微镜下输精管复通术可有效治疗输精管结扎所致的输精管梗阻,输精管梗阻15年以下者的复通率明显高于梗阻15年及以上者。Objective：To evaluate the efficacy of microsurgical vasectomy reversal on patients after vasectomy.Methods： In the study,41 patients after vasectomy were admitted for microsurgical vasectomy reversal.The mean（range） age was 45（29 to 66） years for the men.The mean duration of obstruction was 12 years.All the patients were seen by the surgeon for a complete history and physical examination.Semen analyses proved azoopermia,and their serum levels of sexual hormone were normal.They were all offered scrotal exploration.Microvasovasostomy was performed if the sperm was found in the material coming from the proximal vas lumen.The decision for microvasoepididymostomy was made during surgery,if the fluid was creamy,containing only debris or there was no fluid whatsoever when the vas was milked toward the cut end.Microvasovasostomy was performed in 40 patients,of whom 6 were with lateral microvasoepididymostomy and 1 with bilateral microvasoepididymostomy.The initial semen analysis was then done after usually 3 months postoperatively.Patency was arbitrarily defined as＆gt;10 000 sperm/mL in ejaculate in at least one semen analysis after surgery.Postoperative patency rate and postoperative impregnation rate were followed.Results： The 41 patients were followed up for 3 to 72 months,and 5 cases were lost.In the 28 patients who had obstructions for less than 15 years,3 were lost.Sperm was found by semen analysis in 21 patients.Their sperm density was 2×106 to 46×106 sperms/mL and motility was 0% to 60%.The semen analysis revealed azoospermia in 2 patients after 12 months,who were advised to undergo intracytoplasmic sperm injection.Natural conception occurred in 6 patients followed for more than 12 months.The overall patency rate was 84%（21/25）.Among the patients with a follow-up of ＆gt;6 months,the natural paternity rate was 29%（6/21）.In the 13 patients who had obstructions for more than 15 years,2 were lost.The patency and pregnancy rates were 64%（7/11） and 14%（1/7） respectively.Their sperm d

关 键 词：输精管吻合术 附睾 显微外科手术 输精管切除术 

分 类 号：R697.22[医药卫生—泌尿科学]