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目的:探讨医源性双侧输精管损伤致无精子症的治疗经验。方法:回顾性分析因医源性双侧输精管损伤致无精子症11例患者的临床资料,患者年龄20~33岁,术前诊断为无精子症;既往均有盆腔手术病史,其中7例儿时曾行双侧腹股沟斜疝修补术,4例曾行双侧隐睾下降固定术。结果:术中均行双侧腹股沟区探查,6例患者术中可见双侧输精管腹股沟管内段闭锁,切除闭锁段后,行显微镜下双侧输精管端端吻合术。5例可于内环口处或内环口附近见输精管被离断残端,远端输精管无法寻及,联合腹腔镜探查腹腔后,再行输精管端端吻合术,其中2例因单侧输精管腹腔段缺损较长,无法吻合,行单侧吻合。术后随访3个月至1年,7例患者精液常规查见精子,精子浓度为(0.4~35)×106/ml,精子活力为15%~46%;4例未见精子。结论:有盆腔手术史的无精子症患者,应特别注意医源性输精管损伤的可能,无张力的输精管吻合至关重要,必要时可通过改变解剖路径,缩短输精管行程来重建输精管。
Objective: To explore the experience of treatment of azoospermia induced by iatrogenic bilateral vas deferens. Methods: The clinical data of 11 patients with azoospermia due to iatrogenic bilateral vas deferens were retrospectively analyzed. The patients were aged from 20 to 33 years. Preoperative diagnosis was azoospermia. Previous history of pelvic surgery included 7 children Had bilateral inguinal hernia repair, 4 cases had bilateral cryptorchidism decreased fixation. Results: The bilateral inguinal region exploration was performed during operation. The bilateral vas deferens invagination of the inguinal canal was occluded in 6 patients, and the bilateral vas deferens end anastomosis under microscope. 5 cases can be seen at the end of the inner ring or inner ring near the vas deferens were stump broken, distal vas deferens can not find and combined laparoscopic abdominal exploration, and then vasectomy, including 2 cases due to unilateral vas deferens Abdominal defects longer, can not be consistent, line unilateral. The patients were followed up for 3 months to 1 year. Semen was routinely found in 7 patients. The sperm concentration was (0.4 ~ 35) × 106 / ml and sperm motility was 15% ~ 46%. No spermatozoon was found in 4 patients. CONCLUSION: Patients with a history of pelvic surgery should pay special attention to the possibility of iatrogenic vas deferens injury. Tensionless vas deferens anastomosis is of paramount importance. If necessary, the vas deferens can be reconstructed by changing the anatomic path and shortening the vas deferens stroke.