显微外科技术治疗梗阻性无精子症的新进展

Microsurgical Approaches to the Treatment of Obstructive Azoospermia

显微外科技术在最近 5～ 10年的生殖医学发展中扮演了重要角色。显微外科的睾丸取精技术和附睾取精技术 ,与体外受精和卵细胞内单精子注射技术的结合 ,使得过去一直被认为是难以治疗的因生精功能障碍所致的非梗阻性无精子症的治疗成为现实。与此同时 ,显微外科输精管吻合和输精管附睾吻合的技术革命使治疗梗阻性无精子症的效果显著地改善 ,成为治疗梗阻性无精子症的首选方法。本文着重介绍了显微外科输精管吻合术、输精管附睾吻合术、手术指征与手术成功的要素 ,预测了未来的发展方向 ,讨论了显微外科技术的优势 ,强调了显微外科培训对泌尿外科医生治疗男性不育患者的重要意义。

In the past 5 to 10 years, very few fields in modern medicine have changed so dramatically as reproductive medicine, especially for the treatment of male infertility. Advances have been made in intracytoplasmic sperm injection (ICSI), refined microsurgical reconstructive techniques (vasovasostomy and vasoepididymostomy), and microsurgical techniques of surgical sperm retrieval from the epididymis and testis. All men with epididymal obstruction (obstructive azoospermia) now have the opportunity to father their own biological children. In this article, the authors reviewed the most updated microsurgical vasovasostomy, vasoepididymostomy techniques and surgical indications as well as the key factors for successful microsurgical treatment. They also predicted the future directions and discussed the advantages of microsurgical techniques, emphasized the significant roles of microsurgical training for urological doctors to treat male infertility.