Kapur M M, Sood S, Kochar K P, Paul S, Rao S V
Department of Surgery, All India Institute of Medical Sciences, New Delhi.
Br J Urol. 1989 Jul;64(1):69-71. doi: 10.1111/j.1464-410x.1989.tb05525.x.
Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre-operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre-operative finding. Adverse operative findings included non-canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre-operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.
男性梗阻性不育症的手术并不总是成功的。一些以前未报道过的临床和手术发现可能会影响手术结果。我们研究了182例行输精管附睾吻合术的无精子症患者。确定了对吻合功能产生不利影响的术前和手术发现。精液样本中存在精子意味着吻合成功。睾丸组织学异常是不利的术前发现。不利的手术发现包括附睾管未贯通和附睾发育不全；这两个因素都与高失败率（几乎100%）相关。当切开附睾时未见液体时，78%的患者吻合失败。在没有不利发现的情况下，输精管附睾吻合术的成功率为59%。建议进行术前睾丸活检，并在手术前和手术过程中仔细观察和记录发现，以避免不必要的探查和吻合。
