Monoski Mara A, Schiff Jonathan, Li Philip S, Chan Peter T K, Goldstein Marc
Department of Urology, Cornell Institute for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY 10021-4873, USA.
Urology. 2007 Apr;69(4):800-4. doi: 10.1016/j.urology.2007.01.091.
Vasoepididymostomy outcomes are heavily dependent on the surgeon's microsurgical experience and skill. To avoid back-walling the tubular lumen, the needles are generally placed inside-out through the vasal lumen using double-armed microsutures. These double-armed sutures for infertility microsurgery are very expensive and may be difficult to obtain. We describe a randomized trial that used a novel single-armed suture placement pattern for vasoepididymostomy.
Male adult Wistar rats underwent vasectomy. Two weeks later, vasoepididymostomies were performed using either a single-armed longitudinal intussusception vasoepididymostomy (n = 6) or a standard double-armed longitudinal intussusception vasoepididymostomy (n = 6) technique. After 9 weeks, patency was assessed functionally by evaluating for motile sperm distal to the anastomosis. If no motile sperm were visible, the mechanical patency of the anastomoses was tested by the ability of methylene blue to pass through the surgical anastomosis.
The patency rate for the double-armed vasoepididymostomy group was 100% (6 of 6) compared with 83.3% (5 of 6) for the single-armed vasoepididymostomy group. This difference was not significant (P = 0.50). Sperm granulomas were found in three (50%) of six anastomoses in the double-armed group and five (83%) of six anastomoses in the single-armed vasoepididymostomy group (P = 0.27). The mean operative times for the double and single-armed longitudinal intussusception vasoepididymostomy techniques were similar (35 minutes versus 43 minutes; P = 0.39).
The results of our study have shown that the single-armed suture technique to perform vasoepididymostomy is almost as effective as the double-armed technique. Although we still prefer to use double-armed sutures, we believe that this is a practical and effective alternative when specialized double-armed microsurgical sutures are not available.
输精管附睾吻合术的结果在很大程度上取决于外科医生的显微手术经验和技能。为避免堵塞管腔，通常使用双臂显微缝线通过输精管腔由内向外进针。这些用于不育症显微手术的双臂缝线非常昂贵，且可能难以获得。我们描述了一项随机试验，该试验在输精管附睾吻合术中采用了一种新型的单臂缝线放置方式。
成年雄性Wistar大鼠接受输精管切除术。两周后，分别采用单臂纵向套叠式输精管附睾吻合术（n = 6）或标准双臂纵向套叠式输精管附睾吻合术（n = 6）进行输精管附睾吻合术。9周后，通过评估吻合口远端的活动精子来功能上评估通畅情况。如果未见活动精子，则通过亚甲蓝穿过手术吻合口的能力来测试吻合口的机械通畅性。
双臂输精管附睾吻合术组的通畅率为100%（6/6），而单臂输精管附睾吻合术组为83.3%（5/6）。这种差异不显著（P = 0.50）。在双臂组的6个吻合口中有3个（50%）发现精子肉芽肿，在单臂输精管附睾吻合术组的6个吻合口中有5个（83%）发现精子肉芽肿（P = 0.27）。双臂和单臂纵向套叠式输精管附睾吻合术技术的平均手术时间相似（35分钟对43分钟；P = 0.39）。
我们的研究结果表明，进行输精管附睾吻合术的单臂缝线技术几乎与双臂技术一样有效。虽然我们仍然更喜欢使用双臂缝线，但我们认为当没有专用的双臂显微手术缝线时，这是一种实用且有效的替代方法。
