术前附睾穿刺对梗阻性无精子症患者生殖管道显微重建的影响  

Effect of preoperative epididymal puncture on microsurgical reconstruction of reproductive tract in patients with obstructive azoospermia

作　　者：刘计海 阚懿 戴玉田 赵晓智 徐春璐 宋涛 韩友峰 LIU Jihai;KAN Yi;DAI Yutian;ZHAO Xiaozhi;XU Chunlu;SONG Tao;HAN Youfeng(Department of Andrology,Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine,Nanjing 210008,Jiangsu,China;Department of Andrology,Nanjing Drum Tower Hospital,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京中医药大学鼓楼临床医学院男科,南京210008 [2]南京鼓楼医院男科,南京210008

出　　处：《中国性科学》2024年第3期15-19,共5页Chinese Journal of Human Sexuality

摘　　要：目的探讨术前附睾穿刺是否影响梗阻性无精子症患者生殖管道显微外科重建的手术疗效。方法回顾性分析2020年6月至2022年6月在南京鼓楼医院成功行显微镜下附睾输精管吻合术的86例患者的临床资料,根据术前是否行附睾穿刺活检将其分为穿刺组(n=37)和未穿刺组(n=49),比较分析两组的手术情况、术后精道复通情况及配偶受孕情况。结果穿刺组37例中术后22例复通(59.46%),未穿刺组49例中术后39例复通(79.59%),穿刺组术后复通率低于未穿刺组,差异具有统计学意义(P<0.05)。两组年龄、体重指数比较,差异无统计学意义(P>0.05);穿刺组平均手术时间长于未穿刺组,穿刺组双侧吻合率低于未穿刺组,穿刺组头部吻合率高于未穿刺组,差异均具有统计学意义(P<0.05)。穿刺组22例复通患者中有5例配偶自然受孕(22.73%),未穿刺组39例复通患者中有11例配偶自然受孕(28.21%),两组术后配偶自然受孕率比较,差异无统计学意义(P>0.05)。结论显微重建手术可以为部分梗阻性无精子患者提供更好的生育选择,而术前附睾穿刺可能降低术后生殖管道复通率,需慎重考虑。Objective To investigate whether preoperative epididymal puncture affects the surgical efficacy of microsurgical reconstruction of reproductive tract in patients with obstructive azoospermia.Methods Clinical data of 86 patients who received microsurgical vasoepididymostomy in Nanjing Drum Tower Hospital from June 2020 to June 2022 were retrospectively analyzed.According to whether preoperative epididymal puncture was performed,they were divided into the puncture group(n=37)and the non-puncture group(n=49),and the surgical situation,postoperative seminal tract patency condition,and spouse pregnancy condition were compared and analyzed.Results Among 37 patients in puncture group,22 patients had patency(59.46%).Among 49 patients in non-puncture group,39 patients had patency(79.59%).The patency rate of patients in puncture group was lower than that in non-puncture group,and the difference was statistically significant(P<0.05).There were no significant differences in age and body mass index between the two groups(P>0.05).The average surgical time in puncture group was longer than that in non-puncture group,the bilateral anastomosis rate in puncture group was lower than that in non-puncture group,the head anastomosis rate in puncture group was higher than that of non-puncture group,with the statistically significant differences(P<0.05).Among the 22 patients with patency in the puncture group,spouses of 5 had spontaneous pregnancy(22.73%),while in the non-puncture group,spouses of 11 had spontaneous pregnancy(28.21%).There was no significant difference in the spontaneous pregnancy rate between the two groups(P>0.05).Conclusions Microsurgical reconstruction can provide better reproductive choices for some obstructive azoospermia patients.Preoperative epididymal puncture may reduce the patency rate of reproductive tract after operation,which needs careful consideration.

关 键 词：附睾穿刺 梗阻性无精子症 显微重建 

分 类 号：R697[医药卫生—泌尿科学]