显微镜下单针法纵向套叠输精管附睾吻合术后附睾管-输精管精道复通的影响因素  

Influencing factors of postoperative patency of longitudinal single suture intussusception microsurgical vasoepididymostomy

作　　者：王璐瑶[1] 吕坤龙 张天标[1] 郑涛[1] 南永浩 王瑞[1] WANG Luyao;L Kunlong;ZHANG Tianbiao;ZHENG Tao;NAN Yonghao;WANG Rui(Department of Andrology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院男科,河南郑州450000

出　　处：《现代泌尿外科杂志》2024年第11期964-968,共5页Journal of Modern Urology

摘　　要：目的分析显微镜下单针法纵向套叠输精管附睾吻合术治疗附睾梗阻性无精子症术后附睾管-输精管精道复通的影响因素,为临床提高复通率提供参考。方法回顾性分析郑州大学第一附属医院男科于2020年9月—2023年1月行显微镜下单针法纵向套叠输精管附睾吻合术的82例附睾梗阻性无精子症患者的临床资料,术后门诊和/或电话随访患者术后复通情况及配偶受孕情况。分析患者年龄、病程、身体质量指数(BMI)、既往病史(附睾炎、手术史、无)、术前精浆弹性蛋白酶(SPE)水平、吻合部位、吻合侧别、附睾液镜检精子质量、手术时长及住院时间对术后复通率的影响。结果82例患者的手术均成功实施,随访率95.12%(78/82),78例随访患者中已婚73例,复通率78.21%(61/78),61例复通患者中已婚56例,已婚患者配偶自然受孕率45.21%(33/73)。单因素分析结果显示年龄<30岁、病程<2年、术前SPE水平<290 ng/mL、双侧吻合、体尾部吻合及附睾液镜检有活动精子的患者有更高的术后复通率(P<0.05);BMI、既往病史、附睾液镜检活动精子数量、手术时间及住院时间对术后复通的影响无显著相关性(P>0.05)。多因素logistic回归分析结果显示患者术前SPE水平(OR=0.998,95%CI:0.997~1.000,P=0.008)、吻合部位(OR=10.724,95%CI:2.243~51.283,P=0.003)与术后复通显著相关。结论术前SPE水平和吻合部位是显微镜下输精管附睾吻合术后复通的显著影响因素。年龄<30岁、病程<2年、术前SPE水平<290 ng/mL、双侧吻合、体尾部吻合及附睾液镜检有活动精子的患者术后复通率较高。Objective To analyze the influencing factors of postoperative patency of longitudinal single suture intussusception microsurgical vasoepididymostomy,to provide reference for improving the repetition rate.Methods The clinical data of 82 patients with epididymal obstructive azoospermia who underwent longitudinal single suture intussusception microsurgical vasoepididymostomy in our hospital during Sep.2020 and Jan.2023 were retrospectively analyzed.The postoperative patency and spouse pregnancy were followed up by face to face and/or telephone interview.The effects of age,course of disease,body mass index(BMI),previous medical history(epididymitis,operation history,none),preoperative seminal plasma elastase(SPE)level,anastomosis site,unilateral and bilateral lesion,sperm quality,operation time and hospital stay on the postoperative patency rate were analyzed.Results All operations were successful,the follow-up rate was 95.12%(78/82),78 were married,and the postoperative patency was 78.21%(61/78).Of the 61 patients who achieved patency,56 were married,and the natural pregnancy rate of spouse was 45.21%(33/73).Univariate analysis showed that patients with age<30 years,course of disease<2 years,preoperative SPE level<290 ng/mL,bilateral anastomosis,body or tail anastomosis and motile sperm had higher postoperative patency rate(P>0.05).BMI,previous history,the number of motile sperms examined by epididymal fluid,the length of operation and hospital stay had no significant effects on postoperative patency(P>0.05).The results of multivariate logistic regression analysis showed that preoperative SPE level(OR=0.998,95%CI:0.997-1.000,P=0.008)and(OR=10.724,95%CI:2.243-51.283,P=0.003)were significantly correlated with postoperative patency.Conclusion The preoperative SPE level and anastomosis site are significant influencing factors of postoperative patency,which is higher in patients with age<30 years,course of disease<2 years,preoperative SPE level<290 ng/mL,bilateral anastomosis,body or tail anastomosis and motile sperm.

关 键 词：显微输精管附睾吻合 梗阻性无子精症 附睾梗阻 影响因素 男性不育 精浆弹性蛋白酶 

分 类 号：R699[医药卫生—泌尿科学]