Taniguchi Hisanori, Iwamoto Teruaki, Ichikawa Tomohiko, Nagai Atsushi, Okada Hiroshi, Fujisawa Masato, Tsujimura Akira, Shiraishi Koji, Hibi Hatsuki, Nagao Koichi, Iwasaki Akira, Kamba Tomomi, Tomomasa Hiroshi, Takada Shingo, Matsuda Tadashi
Department of Urology and Andrology, Kansai Medical University, Osaka, Japan.
Int J Urol. 2015 Feb;22(2):213-8. doi: 10.1111/iju.12631. Epub 2014 Sep 23.
To evaluate current outcomes of seminal tract re-anastomoses in Japan, and to compare them with historical data.
A total of 213 patients with obstructive azoospermia who underwent seminal tract re-anastomosis from April 2008 to March 2012 at 25 institutions were enrolled in the present study. The outcomes of the procedure were compared with those reported in a previous multi-institutional study carried out in 2000.
The percentage of partners aged over 35 years was 37%. A microsurgical double-layer anastomosis was carried out 83.0% of the time. Sperm were observed in ejaculate postoperatively in 68.9% and 41.5% of patients who underwent a vasovasostomy or a vasoepididymostomy, respectively. Natural conception occurred in 27.5% of patients after a vasectomy and 32.3% of patients with an epididymal obstruction. Except for the ratio of natural conception in patients with vasal obstruction after herniorrhaphies, there were no significant differences in final ratios of sperm appearance and natural conception between the previously reported study and the present study.
Compared with historical data, contemporary seminal tract re-anastomosis in Japan seems to provide equivalent or better outcomes, depending on the cause of obstruction. Seminal tract re-anastomosis is a valid treatment option for patients with obstructive azoospermia.
评估日本精道再吻合术的当前疗效，并与历史数据进行比较。
本研究纳入了2008年4月至2012年3月期间在25家机构接受精道再吻合术的213例梗阻性无精子症患者。将该手术的疗效与2000年进行的一项先前多机构研究所报告的疗效进行比较。
年龄超过35岁的配偶比例为37%。83.0%的手术采用了显微外科双层吻合术。分别有68.9%和41.5%接受输精管吻合术或输精管附睾吻合术的患者术后在射精中观察到精子。输精管结扎术后27.5%的患者以及附睾梗阻患者中有32.3%自然受孕。除了疝修补术后输精管梗阻患者的自然受孕率外，先前报告的研究与本研究在精子出现的最终比率和自然受孕方面没有显著差异。
与历史数据相比，日本当代精道再吻合术似乎能提供相当或更好的疗效，这取决于梗阻的原因。精道再吻合术是梗阻性无精子症患者的一种有效治疗选择。
