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目的:探讨输精管附睾管显微吻合术(VE)治疗附睾梗阻性无精子症(EOA)附睾吻合部位的选择策略。方法:选取2013年1月至2014年1月就诊的56例确诊为OA并初步诊断为附睾梗阻的男性不育患者,术前根据病史、体检以及阴囊超声对附睾吻合部位进行预测;行阴囊探查术观察附睾梗阻情况,根据触诊和显微镜下观察选择待吻合附睾管;最终根据附睾液中有无活动精子决定吻合部位;对确定为附睾梗阻并在附睾液中找到活精子的患者施行输精管附睾管端侧显微吻合术;术后随访其疗效。结果:56例患者均行双侧阴囊超声检查和阴囊探查术,累计112次,其中行VE术98次(单侧14例,双侧42例),术前病史和体检累计预测吻合部位、超声预测吻合部位、术中首选吻合部位的成功率分别为80.5%(153/190)、80.3%(90/112)和87.4%(90/103)。28例随访成功(随访满12个月),其中19例(67.9%,19/28)于术后2~12个月从精液中检出活动精子,10例(35.7%,10/28)配偶自然受孕成功,均为体尾部吻合病例。结论:术前病史和体检有助于吻合部位的选择,阴囊超声是有效、实用、无创的术前诊断附睾梗阻部位的方法。术中在饱满较硬的附睾中选择最为饱满的附睾管切开,易于获得有活动精子的附睾管行显微吻合。
Objective: To explore the selection strategy of epididymal anastomosis of epididymal obstructive azoospermia (EOA) by vas deferens epididymal microscopic anastomosis (VE). Methods: From January 2013 to January 2014, 56 male infertile patients diagnosed as OA and initially diagnosed as epidural obstruction were enrolled. The anastomotic sites of epididymis were predicted preoperatively according to their medical history, physical examinations and scrotal ultrasound. Scrotal exploration The observation of epididymal obstruction, according to the palpation and microscopic observation to select the epididymal tuberculosis to be anastomosed; ultimately based on the presence or absence of active sperm in the epididymal fluid anastomosis site; on the determination of epididymatic obstruction and in the epididymal fluid to find live sperm in patients with vas deferens The end of the tube microsurgical anastomosis; follow-up after treatment. Results: 56 patients underwent both scrotal scrotal scintigraphy and scrotal exploration for a total of 112 times. VE was performed 98 times (14 cases in one side and 42 cases in both sides). The preoperative history and physical examination predicted the anastomotic sites, The successful rates of the first anastomosis sites were 80.5% (153/190), 80.3% (90/112) and 87.4% (90/103), respectively. Twenty-eight patients were followed up for 12 months, of which 19 (67.9%, 19/28) detected sperm from semen 2 to 12 months postoperatively, while 10 (35.7%, 10/28) spouses Natural conception is successful, are tail anastomosis cases. Conclusion: The preoperative history and physical examination are helpful for the selection of anastomotic site. Scrotal ultrasound is an effective, practical and noninvasive method for the preoperative diagnosis of epididymis obstruction site. Surgery in the full hard epididymis choose the most full of epididymal tube incision, easy to obtain the activity of sperm epididymis line micro-anastomosis.