腹腔镜辅助下输精管吻合术治疗疝修补术后输精管梗阻

Laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction.

作者信息

Uchida Masahiro, Iida Shuichi, Hoshi Kazuhiko, Kojo Kosuke, Tsuchiya Haruki, Yamasaki Kazumitsu, Miyazaki Jun, Iwamoto Teruaki

机构信息

Reproduction Center International University of Health and Welfare Hospital Nasushiobara Japan.

Department of Urology Tsukuba Gakuen Hospital Tsukuba Japan.

出版信息

IJU Case Rep. 2020 Feb 24;3(2):72-75. doi: 10.1002/iju5.12150. eCollection 2020 Mar.

DOI:10.1002/iju5.12150

PMID:32743475

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7292088/

Abstract

INTRODUCTION

Repair of obstructive azoospermia caused by childhood herniorrhaphy may be difficult. Therefore, intracytoplasmic sperm injection using testicular sperm is performed. However, vasovasostomy combined with laparoscopic surgery is challenging.

CASE PRESENTATION

A 42-year-old man underwent inguinal hernia repair at age 3. He had normal testicular size, azoospermia, normal hormone levels (follicle-stimulating hormone, luteinizing hormone, and testosterone), absence of Y chromosome micro deletion, and karyotype:46XY, t(1:21)(p34.1:q22.3). He was diagnosed with obstructive azoospermia. Repeated intracytoplasmic sperm injections using testicular sperm resulted in miscarriages. Vasovasostomy combined with laparoscopic surgery was subsequently performed. Postoperative semen analysis result was almost normal. After intracytoplasmic sperm injection of ejaculated sperm, his wife got pregnant.

CONCLUSION

Even if patients have chromosomal abnormalities, performing microsurgical re-anastomosis first is recommended. To our knowledge, this is the first case of a laparoscopy-assisted vasovasostomy for post-herniorrhaphy vas deferens obstruction in Japan.

摘要

引言

修复儿童期疝气修补术所致的梗阻性无精子症可能具有挑战性。因此，会采用睾丸精子卵胞浆内单精子注射术。然而，输精管吻合术联合腹腔镜手术颇具难度。

病例报告

一名42岁男性在3岁时接受了腹股沟疝修补术。他的睾丸大小正常，无精子症，激素水平正常（促卵泡激素、黄体生成素和睾酮），Y染色体微缺失阴性，核型为：46XY，t(1:21)(p34.1:q22.3)。他被诊断为梗阻性无精子症。多次使用睾丸精子进行卵胞浆内单精子注射均导致流产。随后进行了输精管吻合术联合腹腔镜手术。术后精液分析结果基本正常。在对射出精子进行卵胞浆内单精子注射后，他的妻子怀孕了。