Reynolds R D
New Richmond Family Practice, Ohio 45157.
J Fam Pract. 1994 Dec;39(6):577-82.
The increasing popularity of the no-scalpel vasectomy (NSV) technique in the United States is driven by patient demand for surgical procedures presumed to be less invasive and by the somewhat lower complication rate of the NSV technique. The NSV technique addresses vasal delivery but not vasal occlusion. Intraluminal red-hot wire cautery with sheath closure over the inguinal end of the cut vas (Schmidt's method) has the lowest failure rate of all reasonable vas occlusion methods. The anatomical relationships of scrotal layers can be unclear during the NSV technique. Accurate identification of the sheath layer is critical to sheath interruption if this method of occlusion is to be used. Placement of an absorbable purse-string suture for sheath interruption during the NSV procedure is described. Special attention must be given to placement of one suture bite in the deep (posterior) sheath wall. The vasal occlusion technique described in this paper blends a refined method of vasal delivery (NSV) with the most effective method of vasal occlusion (cautery with sheath interruption).
在美国，无刀输精管结扎术（NSV）技术越来越受欢迎，这是由患者对被认为侵入性较小的手术的需求以及NSV技术相对较低的并发症发生率所推动的。NSV技术解决了输精管输送问题，但未解决输精管闭塞问题。在所有合理的输精管闭塞方法中，用鞘膜封闭切断输精管腹股沟端的腔内红热丝烧灼术（施密特方法）的失败率最低。在NSV技术过程中，阴囊各层的解剖关系可能不清楚。如果要使用这种闭塞方法，准确识别鞘膜层对于鞘膜切断至关重要。本文描述了在NSV手术过程中放置可吸收荷包缝合线进行鞘膜切断的方法。必须特别注意在深层（后部）鞘膜壁上放置一针缝线。本文所述的输精管闭塞技术将一种精细的输精管输送方法（NSV）与最有效的输精管闭塞方法（鞘膜切断烧灼术）相结合。
