Silverstein J I, Mellinger B C
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11042.
J Urol. 1991 Jun;145(6):1288-91. doi: 10.1016/s0022-5347(17)38616-0.
Vasectomy reversal has become a frequently performed surgical procedure with best results obtained with the use of the operating microscope and microsurgical technique. The present study was undertaken to evaluate the use of fibrin glue ("Tisseel", Immuno U.S., Inc.) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Utilizing 60 male Sprague Dawley rats, a conventional two layered sutured anastomosis of vasovasostomy (30 rats) was compared to a fibrin glue technique of vasal anastomosis (30 rats). The fibrin glue technique was performed with two transmural sutures, was unstented, and utilized the biological glue to seal the anastomosis. The contralateral vas of each animal underwent vasectomy and reapproximation of unligated ends so that the rate of spontaneous recanalization could be accessed. Rats were sacrificed at 24 hours, one week, four weeks, and three months postvasovasostomy. The vasal specimens were evaluated for gross patency, presence and size of sperm granuloma, mean flow rates at varying infusion pressures, tensile strength measurements and histologic studies. Combining the one and three month groups, a similar patency rate was obtained by either technique; 83% (n = 18) for the sutured group, and 90% (n = 21) for the fibrin glue group. The rate of spontaneous recanalization of the contralateral vasa in the one and three month animals was 8% (n = 38). The mean flow rates obtained at high and low infusion pressures were not statistically different for the two techniques. The tensile strength of the glue anastomosis averaged 78% of the tensile strength achieved by the conventional sutured technique. The incidence of sperm granuloma after vasovasostomy was 28% for the fibrin glue group and 61% for the sutured group. Additionally, 67% of granulomas were small (less than 3 mm.) in the glue group, compared to only 36% in the sutured group. Histology revealed similar morphological changes in the area of anastomosis with either technique. Operative time for sutured vasovasostomy averaged 24 minutes, compared to an average of 11 minutes for the glue assisted vasovasostomy. The use of fibrin glue allowed the performance of a sperm tight patent anastomosis that had the advantages of reduced incidence of sperm granuloma formation, reduced operative time, and less microsurgical skill required to perform the anastomosis.
输精管复通术已成为一种常施行的外科手术，使用手术显微镜和显微外科技术可获得最佳效果。本研究旨在评估纤维蛋白胶（“Tisseel”，美国Immuno公司）在输精管吻合术中的应用，并将该技术与传统的缝合输精管吻合术进行比较。利用60只雄性斯普拉格-道利大鼠，将传统的两层缝合输精管吻合术（30只大鼠）与纤维蛋白胶输精管吻合技术（30只大鼠）进行比较。纤维蛋白胶技术采用两根贯穿缝合线，不使用支撑物，并利用生物胶封闭吻合口。每只动物的对侧输精管进行输精管切除术，并将近端未结扎的两端重新对合，以便评估自发再通率。在输精管吻合术后24小时、1周、4周和3个月处死大鼠。对输精管标本进行大体通畅性、精子肉芽肿的存在及大小、不同灌注压力下的平均流速、拉伸强度测量和组织学研究。将1个月和3个月组的数据合并，两种技术获得的通畅率相似；缝合组为83%（n = 18），纤维蛋白胶组为90%（n = 21）。1个月和3个月龄动物对侧输精管的自发再通率为8%（n = 38）。两种技术在高灌注压力和低灌注压力下获得的平均流速无统计学差异。胶吻合术的拉伸强度平均为传统缝合技术的78%。输精管吻合术后，纤维蛋白胶组精子肉芽肿的发生率为28%，缝合组为61%。此外，胶组67%的肉芽肿较小（小于3 mm），而缝合组仅为36%。组织学显示，两种技术在吻合区域的形态学变化相似。缝合输精管吻合术的平均手术时间为24分钟，而胶辅助输精管吻合术的平均手术时间为11分钟。使用纤维蛋白胶可进行精子紧密的通畅吻合，具有减少精子肉芽肿形成的发生率、缩短手术时间和减少吻合所需显微外科技术要求等优点。
