[影响小儿腹股沟疝修补术后输精管梗阻经显微输精管吻合术后恢复的因素]

[Factors influencing recovery from childhood inguinal herniorrhaphy-induced vas deferens obstruction after microscopic vasovasostomy].

作者信息

Liang Bing-Bing, Hu Xiao-Zhe, Lü Kun-Long, Zhang Tian-Biao, Zheng Tao, Li Hai-Lu, Zhang Wei-Xing, Wang Rui

机构信息

Research Institute of Andrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450000, China.

出版信息

Zhonghua Nan Ke Xue. 2020 Aug;26(8):717-721.

PMID:33377733

Abstract

OBJECTIVE

To investigate the factors influencing the recovery from childhood inguinal herniorrhaphy (IH)-induced vas deferens obstruction following microscopic vasovasostomy.

METHODS

We retrospectively analyzed the clinical data on 41 cases of microscopic vasovasostomy for obstructive azoospermia in our hospital from July 2015 to September 2018. All the patients had a history of inguinal hernia treated by IH in the childhood. We performed scrotal ultrasonography, semen analysis and seminal plasma biochemistry to confirm vas deferens obstruction preoperatively. If sperm was observed for ≥2 times in semen examination after vasovasostomy, we considered the vas deferens successfully unobstructed.

RESULTS

Microscopic vasovasostomy was successfully completed in 39 of the cases, of which2 were lost to follow-up, with a follow-up rate of 94.8% (37/39). The patients, at the mean age of (25.54 ± 2.85) years and with body mass index (BMI) of (24.92 ± 2.79) kg/m2 and post-IH time of (18.97 ± 2.58) years, were followed up for (13.05 ± 3.74) months. Successful recovery from vas deferens obstruction was observed in 78.4% (29/37) of the patients after IH, 80.0% (16/20) in the < 26-year-olds, 76.5% (13/17) in the ≥26-year-olds (P = 0.795), 75.0% (12/16) in those with BMI < 24.92 kg/m2 , 81.0% (17/21) in those with BMI ≥24.92 kg/m2 (P = 0.807), 78.6% (11/14) in those with post-IH time of < 19 years, 18.3% (18/23) in those with post-IH time of ≥19 years (P = 0.982), 60.0% (12/20) in those with sperm and 82.4% (14/17) in those without sperm found intraoperatively (P = 0.428), 42.9% (3/7) in those treated by unilateral and 82.4% (26/30) in those by bilateral vasovasostomy (P = 0.027). Multivariate logistic regression analysis showed a close correlation between the operation side and postoperative recovery from vas deferens obstruction (P = 0.022).

CONCLUSIONS

For male patients undergoing microscopic vasovasostomy for childhood IH-induced vas deferens obstruction, the operation side is an independent factor influencing postoperative recovery, while age, BMI, post-IH time, and intraoperative presence or absence of sperm are not significantly correlated with it.

摘要

目的

探讨影响小儿腹股沟疝修补术（IH）所致输精管梗阻经显微输精管吻合术后恢复的因素。

方法

回顾性分析2015年7月至2018年9月我院41例因梗阻性无精子症行显微输精管吻合术患者的临床资料。所有患者均有小儿时期腹股沟疝经IH治疗史。术前进行阴囊超声、精液分析和精浆生化检查以确诊输精管梗阻。输精管吻合术后精液检查中若观察到精子≥2次，则认为输精管成功再通。

结果

39例成功完成显微输精管吻合术，其中2例失访，随访率为94.8%（37/39）。患者平均年龄（25.54±2.85）岁，体重指数（BMI）为（24.92±2.79）kg/m²，IH术后时间为（18.97±2.58）年，随访时间为（13.05±3.74）个月。IH术后78.4%（29/37）的患者输精管梗阻成功恢复，26岁以下患者为80.0%（16/20），26岁及以上患者为76.5%（13/17）（P = 0.795）；BMI<24.92 kg/m²的患者为75.0%（12/16），BMI≥24.92 kg/m²的患者为81.0%（17/21）（P = 0.807）；IH术后时间<19年的患者为78.6%（11/14），IH术后时间≥19年的患者为18.3%（18/23）（P = 0.982）；术中发现有精子的患者为60.0%（12/20），无精子的患者为82.4%（14/17）（P = 0.428）；单侧治疗的患者为42.9%（3/7），双侧输精管吻合术的患者为82.4%（26/30）（P = 0.027）。多因素logistic回归分析显示手术侧与输精管梗阻术后恢复密切相关（P = 0.022）。