Pryor J L, Fusia T, Mercer M, Mills S E, Howards S S
Department of Urology University of Virginia Health Sciences Center, Charlottesville.
J Urol. 1991 Aug;146(2):477-80. doi: 10.1016/s0022-5347(17)37828-x.
We have previously shown that the human vas deferens does not change in cross-sectional size between birth and the middle of puberty. This suggests that if the human vas is injured prior to mid-puberty, repair by a traditional microsurgical vasovasostomy may be technically difficult. We propose that a chromic stent can be used to assist in the repair of vas injured before mid-puberty. This hypothesis was tested in Sprague-Dawley rats. At three weeks of age, male offspring were divided into three groups (eight to nine rats/group): 1) Sham group--a sham operation at three weeks, 2) VV group--bilateral transection of vasa at three weeks followed by a delayed repair at eight weeks by microsurgical vasovasostomy without a stent, 3) Stent group--bilateral transection of vasa at three weeks followed by immediate repair by aligning the lumens with a 6-0 chromic intravasal stent (suture) and holding the transected ends together with several seromuscular sutures. At four months all rats were fertility tested and a score was given to each rat (mean number of concepti among three females for each male rat). Analysis of anastomotic patency by flow rates and histology was performed. There was no statistical difference in the mean fertility score of 6.85 in the Stent group compared to 7.83 in the Sham group. However, a fertility score of 0.71 in the VV group was significantly decreased compared to the Stent and Sham group (p = .0003), despite no statistical difference between the groups in patency. This suggests that a recognized injury to the pre-pubertal human vas should be immediately repaired and the repair can be done using 6-0 chromic suture as an intravasal stent to help align the lumina of the smaller pre-pubertal vas.
我们之前已经表明，人类输精管在出生至青春期中期之间，其横截面积大小并无变化。这表明，如果人类输精管在青春期中期之前受损，那么通过传统显微外科输精管吻合术进行修复在技术上可能存在困难。我们提出，可以使用铬制支架来辅助修复青春期中期之前受损的输精管。这一假设在斯普拉格-道利大鼠身上进行了验证。在三周龄时，将雄性后代分为三组（每组八至九只大鼠）：1）假手术组——在三周龄时进行假手术；2）输精管吻合术组——在三周龄时双侧切断输精管，八周时通过显微外科输精管吻合术进行延迟修复，不使用支架；3）支架组——在三周龄时双侧切断输精管，随后立即通过使用6-0铬制血管内支架（缝线）使管腔对齐，并通过数针浆肌层缝线将切断端固定在一起进行修复。在四个月时，对所有大鼠进行生育能力测试，并给每只大鼠打分（每只雄性大鼠与三只雌性大鼠交配后的平均受孕数）。通过流速和组织学分析吻合口通畅情况。支架组的平均生育得分6.85与假手术组的7.83相比，无统计学差异。然而，输精管吻合术组的生育得分0.71与支架组和假手术组相比显著降低（p = .0003），尽管各组在通畅性方面无统计学差异。这表明，青春期前人类输精管的明显损伤应立即进行修复，并且可以使用6-0铬制缝线作为血管内支架来帮助对齐较小的青春期前输精管的管腔进行修复。
