Hopps Carin V, Goldstein Marc
Center for Male Reproductive Medicine and Microsurgery, Cornell Institute for Reproductive Medicine and Department of Urology, New York Weill-Cornell Medical Center, New York, New York, USA.
J Urol. 2006 Nov;176(5):2077-9; discussion 2080. doi: 10.1016/j.juro.2006.07.042.
We determined the feasibility and outcome of microsurgical reconstruction of the excurrent ductal tract in men with obstruction secondary to iatrogenic injury to the epididymis from hydrocelectomy.
A retrospective chart review was done to identify men with iatrogenic injury to the epididymis or scrotal vas deferens and a history of hydrocelectomy. The outcome of microsurgical reconstruction was assessed by postoperative semen analysis. Pregnancy data were noted in patients actively attempting to conceive at a followup of 6 months or greater.
Eight men were found to have iatrogenic injury to the epididymides (6) or scrotal vas deferens (2) due to previous hydrocelectomy. Injury was bilateral in 4 men and unilateral in 4 with contralateral testicular absence, dysfunction or obstruction resulting from different etiologies, rendering all patients azoospermic. The mean obstructive interval was 16 years (range 6 to 32). Bilateral and unilateral vasoepididymostomy was performed in 4 and 2 men each, and crossed vasovasostomy was performed in 2. Postoperative semen analysis data were available on 6 men. A patent microsurgical anastomosis was observed in 5 of 6 cases (83%). Four of the 5 men with patency had a followup of greater than 6 months, of whom 3 actively pursued conception. One pregnancy was achieved naturally and 1 was achieved by in vitro fertilization with intracytoplasmic sperm injection.
Hydrocelectomy may result in inadvertent injury to the excurrent ductal tract, causing obstruction and infertility. Microsurgical reconstruction results in the restoration of spermatozoa to the ejaculate in 83% of cases. The return of spermatozoa to the ejaculate may provide the couple with an opportunity to conceive naturally or through assisted reproduction.
我们确定了对因鞘膜积液手术导致附睾医源性损伤而出现梗阻的男性患者，进行输出管道显微外科重建的可行性及结果。
进行一项回顾性病历审查，以确定有附睾或阴囊段输精管医源性损伤且有鞘膜积液手术史的男性患者。通过术后精液分析评估显微外科重建的结果。在随访6个月或更长时间时，记录积极尝试受孕患者的妊娠数据。
发现8名男性因既往鞘膜积液手术导致附睾（6例）或阴囊段输精管（2例）医源性损伤。4名男性为双侧损伤，4名男性为单侧损伤，对侧睾丸因不同病因出现缺如、功能障碍或梗阻，导致所有患者无精子症。平均梗阻时间为16年（范围6至32年）。4名男性进行了双侧输精管附睾吻合术，2名男性进行了单侧输精管附睾吻合术，2名男性进行了交叉输精管吻合术。6名男性有术后精液分析数据。6例中有5例（83%）观察到显微外科吻合通畅。5例通畅的男性中有4例随访时间超过6个月，其中3例积极尝试受孕。1例自然受孕，1例通过卵胞浆内单精子注射体外受精受孕。
鞘膜积液手术可能导致输出管道意外损伤，引起梗阻和不育。显微外科重建在83%的病例中可使精子恢复至射精精液中。精子恢复至射精精液中可为夫妇提供自然受孕或通过辅助生殖受孕的机会。
