附睾梗阻性无精子症的手术治疗

目的 评价附睾梗阻性无精子症(EOA)的手术效果和影响因素. 方法回顾性分析51例EOA患者的临床资料.患者均在硬膜外麻醉下行阴囊探查术.放大镜辅助下,行单层纵向2针套叠式输精管附睾吻合术(LIVE).收集资料包括手术方法、随访时间、术后精子数平均值、a级精子百分率及复通率和受孕率. 结果 平均手术时间(134±36)min.49例一侧或双侧附睾有精子检出,其中1例一侧附睾对侧输精管检出精子;2例附睾未检出精子.49例附睾找到精子者中,48例行单侧或双侧LIVE,1例行单侧LIVE对侧输精管端端吻合.48例行单纯LIVE者失访4例,余44例随访7～17个月,32例精液中检出精子,复通率为72.7%;精子总数平均为(24±23)×106个;28例(87.5%)精液中检出a级精子,a级精子平均为(12.0±11.2)%.39例随访12个月,其中10例妊娠,受孕率为25.6%.术后妊娠与吻合口位置有关,本组妊娠均为吻合部位在尾部者. 结论 放大镜辅助下的LIVE操作简单、费用低,并能取得满意的复通率和受孕率;术中应考虑吻合口位置对妊娠的影响.

Surgical treatment for epididymal obstructive azoospermia

Objective To discuss the clinical outcomes of surgical treatment on epididymal obstructive azoospermia (EOA) and the factors affecting clinical results. Methods The clinical data of 51 EOA patients who underwent single layer longitudinal 2-suture intussusception vasoepididymostomy (LIVE) were retrospectively analyzed. The months of follow up, mean level of sperm count per ejaculate and percentage of grade A sperm were collected. Patency and pregnancy rates were recorded during followups. Results A total of 51 men were taken scrotal exploration. Sperms were bilaterally or unilaterally present in epididymal fluid in 49 cases, including 1 case had sperm in one side of the epididymal fluid and the contralateral vasal fluid. No sperm was found in epididymis in 2 cases. Bilateral and unilateral LIVE were performed in 48 cases. 44 were followed for more than 6 months and 39 for more than 1 year. Sperm was present in ejaculate in 32 of cases, the overall patency rates were 72.7%. The mean sperm count was (24±23) × 106 per ejaculate. Grade A sperm was present in the ejaculate in 28 cases with a mean levels of (12± 11.2)%. A total of 10 cases achieved pregnancy.Pregnancy was achieved only when the site of anastomosis was at cauda epididymis. Conclusions Loupe-assisted LIVE, with lower cost and simplified surgical procedure, could achieve optimistic patency outcomes and pregnancy results. Data of this paper also suggested that it should be taken into account that pregnant outcome was related to the site of anastomosis.