输精管附睾显微吻合术治疗梗阻性无精症44例分析  

Microsurgical vasoepididymostomy in treatment of obstructive azoospermia:44 cases report

作　　者：王明松[1] 孙中义[1] 张勇[1] 周波[1] 罗勇[1] 李珂[1] 张克勤[1] 靳风烁[1] 李彦锋[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所泌尿外科,重庆400042

出　　处：《第三军医大学学报》2014年第24期2481-2484,共4页Journal of Third Military Medical University

基　　金：大坪医院全军计划生育优生优育中心人精子蛋白与男性不育关系研究课题资助(505-1539)~~

摘　　要：目的分析附睾梗阻所致无精症患者行输精管附睾显微吻合术后的复通率和自然怀孕率以及吻合部位对复通率的影响。方法回顾分析我院2012年3月至2014年3月收治的44例附睾梗阻所致无精症患者行输精管附睾显微吻合术的临床资料,根据术中发现和吻合部位的不同等情况,随访观察并分析患者术后的复通率和自然怀孕率。结果44例患者年龄20-58（34.7±8.3）岁。包括双侧吻合39例,单侧吻合5例;行附睾尾部吻合25例,附睾体部吻合8例,附睾头部吻合11例。平均随访时间9.57（3-24）个月,总体复通率为70.5%（31/44）,自然怀孕率为22.7%（10/44）。精子密度0-42×10^6/m L[（13.97±13.07）×10^6/m L],精子活力0-57%（A＋B级）。双侧吻合、单侧吻合的复通率分别为76.9%、20.0%,自然怀孕率分别为28.2%、0。附睾尾部、附睾体部、附睾头部吻合的复通率分别为80.0%、75.0%、45.5%。结论输精管附睾显微吻合术是治疗附睾梗阻所致无精症患者的有效方法,有条件进行双侧吻合、近附睾尾部吻合可获得更高的总体复通率和自然怀孕率。Objective To investigate the patency rate and natural pregnancy rate after microsurgical vasoepididymostomy（MVE） and the effect of the anastomosis site on the patency rate in patients with obstructive azoospermia（OA）.Methods Forty-four OA cases underwent MVE in our hospital from March2012 to March 2014.The clinical data,intraoperative findings and postoperative follow-up results were collected,and the patency rate and natural pregnancy rate were statistically analyzed.Results The mean age of the 44 patients was 34.7 years old（ranged from 20 to 58 years old）.Thirty-nine cases underwent bilateral anastomosis,while 5 cases underwent unilateral anastomosis.The cases of anastomosis at the caput,corpus and cauda were 11,8 and 25,respectively.The average follow-up period was 9.57 months（ranged from 3 to 24months）.The total patency rate was 70.5%（31 /44）,and the natural pregnancy rate was 22.7%（10 /44）.The sperm density was（0-42） × 10^6/ m L [（13.97 ± 13.07） × 10^6/ m L].The sperm motility was 0%-57%（A ＋ B grade）.The patency rates of the patients with bilateral anastomosis and unilateral anastomosis were76.9% and 20%,respectively,while the natural pregnancy rates were 28.2% and 0,respectively.The patency rates of the patients with caput anastomosis,corpus anastomosis,and caudal anastomosis were 45.5%,75.0%,and 80.0%,respectively.Conclusion MVE is an effective approach for the treatment of OA caused by epididymis obstruction.The bilateral anastomosis and the caudal anastomosis may result in higher patency rate and natural pregnancy rate.

关 键 词：梗阻性无精症 输精管附睾吻合 治疗 

分 类 号：R616.2[医药卫生—外科学] R697.22[医药卫生—临床医学]