Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
J Urol. 2010 Apr;183(4):1489-92. doi: 10.1016/j.juro.2009.12.027. Epub 2010 Feb 20.
Surgical reconstruction is an important treatment option for obstructive azoospermia. Vasoepididymostomy results have primarily been described in men with previous vasectomy. We evaluated vaso-epididymal anastomosis outcomes using a 2-suture microsurgical intussusception technique with longitudinal suture placement in men with idiopathic obstructive azoospermia.
Between April 2007 and May 2009, 24 men with idiopathic obstructive azoospermia underwent 2-layer vaso-epididymal anastomosis using a 2-suture intussusception technique. Two double armed 10-zero polyamide sutures were placed parallel to each other longitudinally along the epididymal tubule to intussuscept the tubule into the lumen of the vas deferens for the inner layer of the anastomosis. Patency was assessed by return of sperm in the semen.
A total of 23 men with a mean age of 31 years provided at least 1 postoperative semen sample. All had a mean 67-month history of primary infertility. In 11 men (48%) patency was noted a mean of 6.6 months (range 3 to 15) after surgery. One patient reported pregnancy by natural conception. Men with motile sperm in the epididymal fluid and those with bilateral surgery were more likely to have a patent anastomosis.
Within 1 year after surgery approximately half of the men who underwent longitudinal vaso-epididymal anastomosis for idiopathic azoospermia had return of sperm in the ejaculate.
手术重建是梗阻性无精子症的重要治疗选择。以前列腺切除术为基础的血管吻合术的结果已经主要描述。我们采用双缝线套入式显微外科技术，使用纵向缝线放置，评估了特发性梗阻性无精子症患者的血管-附睾吻合术结果。
2007 年 4 月至 2009 年 5 月，24 例特发性梗阻性无精子症患者接受了 2 层血管-附睾吻合术，采用双缝线套入式显微外科技术。将两条双股 10-零聚酰胺缝线平行放置在附睾管上，进行纵向套叠，将管套入输精管内腔，形成吻合术的内层。通过精液中精子的恢复来评估通畅性。
23 例平均年龄 31 岁的男性提供了至少 1 份术后精液样本。所有患者均有原发性不育的平均 67 个月病史。11 例（48%）患者在手术后平均 6.6 个月（范围 3 至 15）时观察到通畅。1 例患者报告自然受孕妊娠。在附睾液中有活动精子的男性和接受双侧手术的男性更有可能出现吻合通畅。
在手术后 1 年内，大约一半接受特发性无精子症纵向血管-附睾吻合术的男性在精液中恢复了精子。
