首次输精管吻合术失败后再次显微外科吻合术临床-第三军医大学学报.DOC

PAGE 1 首次输精管吻合术失败后再次显微外科吻合术临床效果观察 颜成裕1 李田妹2 （1湛江市计划生育服务中心2湛江市第三人民医院） [摘要] 目的：探讨输精管结扎术后首次吻合术失败的原因和再次显微外科吻合术的复通效果。方法：对56例输精管首次吻合术失败患者再次显微外科吻合术的术中发现和再次显微外科吻合术的临床效果进行分析。结果：56例患者再次显微外科吻合输精管112条，首次吻合口对位不正占16.07%（18/112），吻合部位有漏管形成占21.43%（24/112），吻合部位粘连堵塞占55.36%（62/112），附睾管堵塞占7.14%（8/112），首次吻合术时输精管结扎结节未切除占57.14%（64/112）。再次显微外科吻合术后随访1年以上，术后1年查精子密度达正常者60.71%（34/56），有精子但数量未达正常者14.29%（8/56），无精子者25%（14/56）。结论：输精管结扎术后的首次吻合术造成吻合部位粘连堵塞是术失败的主要原因，其它原因还有吻合口对位不正、漏管形成、原输精管结扎结节未切除等。再次显微外科吻合术后的精子再现率较首次吻合术明显下降。因此，首次输精管吻合术时的规范操作是提高吻合术后成功率的关键。 [关键词] 输精管吻合术 输精管结扎术 显微外科 精子 For the first time after the failure of the vas deferens anastomosis re-microscopy observation of clinical effects of surgical anastomosis.Yan chen yu, Li tian mei, Family Planning Service Center in Zhanjiang City,Guandong 524043 [Abstract] Objective: Of the first anastomosis after vasectomy failure of microsurgical anastomosis and re-pass effect of the complex. Method: For the first time in 56 cases of vas deferens anastomosis in patients with failure of microsurgical re-anastomosis of the surgery and re-found the clinical microsurgical anastomosis analysis of the effects. Results: 56 cases of microsurgical re-anastomosis in patients with vas deferens 112, anastomotic alignment errors accounted for 16.07%(18/112), anastomosis site Youlou tube formation accounted for 21.43% (24/112), anastomosis sites accounted for 55.36% adhesion blocking (62/112), epididymal tube blockage accounts for 7.14% (8 / 112), the first time anastomosis nodules are not removed when the vasectomy accounted for 57.14% (64/112). Again one microsurgical anastomosis were followed up more than one year, after a year investigation with normal sperm density of 60.71% (34/56), with normal sperm but the number was below the 14.29% (8 / 56), no sperm were 25 % (14/56). Conclusion: The first vasectomy anastomosis anastomosis site caused by the failure of adhesion blocking is the main reason for surgery, others, anastomotic alignment is not correct, d