显微附睾-输精管吻合两种不同术式复通率的比较  

Longitudinal intussusception versus end-to-side vasoepididymostomy:Comparison of their recanalization rates

作　　者：赵鲁刚[1] 陈红 刘贵华[1] 方丛[1] 梁晓燕[1] 张靖[1] ZHAO Lu-gang;CHEN Hong;LIU Gui-hua;FANG Cong;LIANG Xiao-yan;ZHANG Jing(Center of Reproductive Medicine/Research Institute of Biomedical Innovation,The Sixth Hospital Affiliated to Sun Yat-sen University,Guangzhou,Guangdong 510655,China)

机构地区：[1]中山大学附属第六医院生殖医学中心/广州市黄埔区中六生物医学创新研究院,广东广州510655

出　　处：《中华男科学杂志》2024年第11期1002-1008,共7页National Journal of Andrology

摘　　要：目的:探讨显微镜下附睾-输精管吻合两种不同吻合方法的复通率差异。方法:回顾性分析2013年10月至2024年7月127例接受显微镜下输精管-附睾吻合的梗阻性无精子症患者的临床资料,按照不同的吻合方式分为端侧组(40例,四针端侧吻合)和套叠组(87例,纵向两针套叠式吻合),比较两组复通率、显微吻合操作时间以及年龄、睾丸体积、FSH之间的差异。结果:127例患者中90例吻合术后精液出现精子(70.9%),两组患者的年龄、睾丸体积、FSH无统计学差异(P>0.05),均未出现严重的手术并发症;显微吻合操作时间端侧组长于套叠组[22.0(20.0,25.8)min/侧vs 17.0(15.0,23.0)min/侧,P<0.05],复通率端侧组高于套叠组(85.0%vs 64.4%,P<0.05)。吻合部位在附睾头部的共11例,复通率36.4%(端侧组50.0%,套叠组33.3%)。结论:四针端侧法输精管-附睾吻合比纵向两针套叠式吻合复通率更高;附睾头部吻合总体复通率低,端侧吻合是否更具优势须进一步观察。Objective:To compare the recanalization rate of 2-suture longitudinal intussusception vasoepididymostomy(LIVE)with that of 4-suture end-to-side vasoepididymostomy(ESVE).Methods:This retrospective case-control study included 127 cases of obstructive azoospermia(OA)treated by LIVE(n=87)or ESVE(n=40)in our Center of Reproductive Medicine from October 2013 to July 2024.We analyzed the clinical data and compared the age,testis volume,level of serum follicle-stimulating hormone(FSH),operation time and postoperative recanalization rate between the two groups.Results:Spermatozoa were observed in 90(70.9%)of the 127 cases after surgery.There were no statistical differences in age,testis volume and FSH between the two groups of patients(all P>0.05),and nor were there any serious surgical complications.The operation time was significantly longer in the ESVE than in the LIVE group(22.0[20.0-25.8]vs 17.0[15.0-23.0]min,P<0.05),while the postoperative recanalization rate remarkably higher in the former than in the latter group(85.0%vs 64.4%,P<0.05).Vasoepididymostomy was performed at the caput epididymis in 11 cases,with a higher recanalization rate in the ESVE than in the LIVE group(50.0%[1/2]vs 33.3%[3/9]).Conclusion:ESVE achieved a higher postoperative recanalization rate than LIVE in the treatment of OA,but its advantages need further investigation.

关 键 词：梗阻性无精子症 附睾-输精管吻合 纵向两针套叠式吻合 端侧吻合 显微外科 复通率 

分 类 号：R699.8[医药卫生—泌尿科学]