输精管结扎术四种不同残端处理与节育效果的比较性研究

A comparitive study on effects of vasectomy with four different treatment of cut vas ends

８１６例自愿接受输精管绝育术男子按照节育手术常规施行输精管结扎术，受术者随机均分为４个队列，分别施行不同的输精管残端处理方法：（１）单纯两断端结扎；（２）结扎加精索筋膜隔离；（３）结扎加苯酚涂灼；（４）电灼。术中以１：３０００新洁尔灭溶液每侧输精管５ｍｌ行精囊灌注，术后３年４种方法精子消失率分别为９０．０％（１８０／２００），９４．１％（１７５／１８６），９３．７％（１７９／１９１）及９４．５％（１７２／１８２），术后并发症为０．４％（３／８１６）。在此对输精管结扎术后自发再通问题进行了讨论，并认为１：３０００新洁尔灭溶液行精囊灌注是安全可行的。

volunteers for vasectomy were randomly allocated in four groups,where vasectomies were perforilled by the no-scalpel technique but the cut vas ends were treated with different methods.1)Simple ligation group:1 cm vas deferens was removed and each cut ends were ligated with 1 suture thread.(2)Sheath separation group:the proximal cut ends were sutured inside the vas sheath.(3)Chemical cautery group: each cut vas ends were treated with phenol,95%alcohol and physiological saline swabs in given order.4)Electrocautery group:after removing 1cm vas deferens the electrocautery needle was in-serted into inner diameter of each cut vas ends.Before treating the cut vas ends 1/3 000 bromogeramine 5ml were slowly injected into seminal vesicle to kill the residual sperms. The follow-up survcy of the re- sults showed that the sperm disappearance rates in semen one to three years after vasectomy were 90.0% (180/200),94.1%(175 / 186),93.7%(179 /191) and 94.5%(172 / 182) in respect to the four different treatment of cut vas ends mentioned above.The overall incidence of complications was as low as 0.4% (3/816).Spontaneous recanalization after vasectomy was discussed and injection with 1/3 000 bromogeramine into seminal vesicle was recommended as a safe and feasible method.