Ball R A, Steinberg J, Wilson L A, Loughlin K R
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Urology. 1993 May;41(5):479-83. doi: 10.1016/0090-4295(93)90515-c.
An evaluation of vas reanastomoses in rats comparing suture only, carbon dioxide (CO2) laser-assisted, and fibrin-based tissue adhesive was performed in our laboratory. A cohort of 60 known fertile male Sprague Dawley rats initially underwent lower midline abdominal exploration and transection of their vas deferens bilaterally, followed by immediate microsurgical vasovasostomy by one of the three experimental methods. All groups initially had the severed vasa ends coapted by two or three transmural (mucosa through serosa) sutures of 10-0 nylon under an operating microscope. The conventionally sutured group had an additional four to six nylon 10-0 sutures placed externally in the serosa only to complete the anastomosis. The CO2 laser-assisted group underwent laser welding with denaturation of the serosa to seal the anastomosis. A fibrin-based tissue adhesive, produced by combining human cryoprecipitate and thrombin, was placed topically over the coapted vas ends to seal the anastomosis in the third group. Postoperative evaluation revealed similarities among the three surgical groups with the fibrin-based tissue adhesive group resulting in the highest patency rate (89%) and pregnancy rate (85%) as well as the lowest granulation rate (18%) and shortest operative time (27 minutes). The laser-assisted group resulted in the lowest pregnancy rate (68%), while the sewn anastomosis group had the lowest patency rate (76%). Both laser-assisted and conventionally sewn vasectomy reversals required significantly longer operative time (39 and 46 minutes, respectively) compared with the fibrin-based tissue adhesive-assisted procedures (p < 0.01). This study provides evidence that alternative microsurgical techniques may be utilized to perform uncomplicated, expeditious, and successful vasectomy reversals.
我们实验室对大鼠输精管再吻合术进行了评估，比较了单纯缝合、二氧化碳（CO₂）激光辅助和纤维蛋白基组织粘合剂三种方法。60只已知可育的雄性斯普拉格·道利大鼠首先接受下腹部中线探查，并双侧切断输精管，然后立即通过三种实验方法之一进行显微外科输精管吻合术。所有组最初都在手术显微镜下用两根或三根10-0尼龙缝线进行全层（从黏膜到浆膜）缝合，将切断的输精管两端吻合。传统缝合组在浆膜外额外放置四到六根10-0尼龙缝线以完成吻合。CO₂激光辅助组进行激光焊接，使浆膜变性以封闭吻合口。第三组将人冷沉淀和凝血酶混合制成的纤维蛋白基组织粘合剂局部涂抹在吻合的输精管两端以封闭吻合口。术后评估显示，三个手术组之间存在相似之处，纤维蛋白基组织粘合剂组的通畅率最高（89%）、妊娠率最高（85%）、肉芽形成率最低（18%）且手术时间最短（27分钟）。激光辅助组的妊娠率最低（68%），而缝合吻合组的通畅率最低（76%）。与纤维蛋白基组织粘合剂辅助手术相比，激光辅助和传统缝合的输精管复通术所需的手术时间明显更长（分别为39分钟和46分钟，p < 0.01）。这项研究提供了证据，表明可以采用替代的显微外科技术来进行简单、快速且成功的输精管复通术。
