Sabanegh E, Thomas A J
Department of Urology, Cleveland Clinic Foundation, Ohio 44195.
Fertil Steril. 1995 Feb;63(2):392-5. doi: 10.1016/s0015-0282(16)57374-9.
To review the indications, surgical technique, and results of crossover transseptal vasoepididymostomies for treatment of complex obstructive azoospermia and oligospermia.
Retrospective review of our experience with crossover transseptal end-to-side vasoepididymostomies in 10 men.
Ten men underwent crossover transseptal end-to-side vasoepididymostomies. Nine men had primary and one had secondary infertility. Seven men were azoospermic, and the remaining 3 had severe oligospermia (sperm density < 1 x 10(6)/mL). All had a combination of irreparable ipsilateral ductal obstruction or agenesis with a normal testis and a poorly functional or absent contralateral testis. Contralateral testicular atrophy was associated with a prior hernia repair in 3 men, varicocele-induced atrophy in 2, and severe orchitis in 2. Cryptorchidism, testicular torsion, and one unknown cause were reported for three others. Congenital absence of the vas deferens caused the ipsilateral ductal pathology in 5 men. Three men had a vas injury from pediatric inguinal surgery, and 2 had an idiopathic vas obstruction.
Twelve microsurgical crossover transseptal vasoepididymostomies were performed (2 men had repeat procedures). Anastomosis was performed to the caput in five men, the corpus in two, and the cauda in three men. Eight of nine men followed for 6 months or more had sperm in their ejaculate. Two of seven couples have established pregnancies. Total sperm counts ranged from 18 to 201 x 10(6) (mean, 98.1 x 10(6)) with motility of 5% to 37% (mean, 13%). Men with congenital absence of the vas deferens had significantly lower postoperative total sperm counts than men with all other causes of ductal pathology: 37.8 x 10(6) versus 135 x 10(6). No other characteristics (type of infertility, preop semen analysis, cause of testicular pathology, site of epididymal anastomosis) were useful predictors of postoperative sperm counts.
If there is a solitary functioning testis with irreparable excurrent ductal obstruction or agenesis, a crossover transseptal vasoepididymostomy can restore patency in most men.
回顾交叉经中隔输精管附睾吻合术治疗复杂性梗阻性无精子症和少精子症的适应证、手术技术及结果。
对10例男性患者行交叉经中隔端侧输精管附睾吻合术的经验进行回顾性分析。
10例男性患者接受交叉经中隔端侧输精管附睾吻合术。9例为原发性不孕，1例为继发性不孕。7例为无精子症，其余3例为严重少精子症（精子密度<1×10⁶/mL）。所有患者均存在同侧不可修复的输精管梗阻或发育不全合并正常睾丸以及对侧睾丸功能不良或缺失的情况。3例患者对侧睾丸萎缩与既往疝修补术有关，2例与精索静脉曲张所致萎缩有关，2例与严重睾丸炎有关。另外3例分别报告为隐睾、睾丸扭转及1例病因不明。5例患者同侧输精管病变由先天性输精管缺如引起。3例患者因小儿腹股沟手术导致输精管损伤，2例为特发性输精管梗阻。
共进行了12次显微交叉经中隔输精管附睾吻合术（2例患者接受了再次手术）。5例患者吻合至附睾头，2例至附睾体，3例至附睾尾。9例随访6个月或更长时间的患者中有8例精液中出现精子。7对夫妇中有2对已成功受孕。总精子数为18～201×10⁶（平均98.1×10⁶），精子活力为5%～37%（平均13%）。先天性输精管缺如的患者术后总精子数显著低于其他所有输精管病变原因的患者：37.8×10⁶对比135×10⁶。没有其他特征（不孕类型、术前精液分析、睾丸病变原因、附睾吻合部位）可作为术后精子数的有效预测指标。
如果存在一个具有功能的孤立睾丸且伴有不可修复的输出管道梗阻或发育不全，交叉经中隔输精管附睾吻合术可使大多数男性恢复输精管道通畅。
