Shapiro E I, Silber S J
Fertil Steril. 1979 Nov;32(5):546-50. doi: 10.1016/s0015-0282(16)44357-8.
The presence of a sperm granuloma at the vasectomy site prevents epididymal pressure build-up, perforation, and the formation of an epididymal sperm granuloma. It thus enhances reversibility of the vasectomy and lessens the likelihood of epididymal discomfort. In two prospective vasectomy series, a sperm granuloma was intentionally allowed to form by not sealing the testicular end of the vas. The sperm granuloma resulted in no instance of orchialgia, but created a greater risk of spontaneous recanalization. This latter problem could only be solved by more careful sealing of the upper end of the vas. In a separate series of nine patients vasectomized elsewhere and specifically referred to us for chronic and persistent postvasectomy orchialgia, seven had no sperm granuloma at the vasectomy site. Pain in these cases was localized in the epididymis and was relieved by vasovasotomy. Any technique of vasectomy carries a very small risk of orchialgia, whether due to the presence of a sperm granuloma at the vasectomy site or to increased epididymal pressure.
输精管结扎部位出现精子肉芽肿可防止附睾压力积聚、穿孔以及附睾精子肉芽肿的形成。因此，它提高了输精管结扎的可逆性，并降低了附睾不适的可能性。在两个前瞻性输精管结扎系列研究中，通过不封闭输精管的睾丸端有意让精子肉芽肿形成。精子肉芽肿未导致一例睾丸炎，但增加了自然再通的风险。后一个问题只能通过更仔细地封闭输精管上端来解决。在另一组由其他地方转诊至我们这里专门治疗慢性持续性输精管结扎术后睾丸炎的9例患者中，7例在输精管结扎部位没有精子肉芽肿。这些病例的疼痛局限于附睾，通过输精管吻合术可缓解。任何输精管结扎技术都有非常小的睾丸炎风险，无论是由于输精管结扎部位存在精子肉芽肿还是附睾压力增加。
