输精管内滤过装置长期植入后复通效果的研究

A study of reversal of vas deferens after long-term intra vas device implantation

目的：探讨输精管滤过装置（IVD）植入术对远期复通效果的影响。方法4例输精管滤过装置（IVD）植入术后4-10年的患者，术中探查并切除2.5-5.5cm长输精管，行输精管端端吻合术；2例切除段输精管送病检；术后定期复查精液常规。结果1年内随访结果：（1）复通效果：仅1例（切除长度在3 cm内）术后精液恢复正常（精子浓度均＞ 20 × 10^6/mL），其他3例均为严重少精子症且其中1例3个月及之后精液检查为无精子症，考虑术后继发吻合口梗阻；（2）受孕率：2例有生育要求的，仅1例（精液恢复正常）术后6个月女方妊娠；（3）淤积症状改善：2例因附睾淤积症要求手术治疗，术后改善明显，阴囊胀痛基本消失。2例病理报告：输精管平滑肌组织增生。结论输精管滤过装置（IVD）具有良好的生物相容性，术后近期复通效果满意，但是，作为腔内物理装置，长期刺激管壁，引起管壁组织增生，可能导致长段输精管损伤，由于研究样本例数较少，其远期复通效果需要进一步评价。

Objective To investigate the effects of long-term intra vas device （IVD） implantation on reversal of vas deferens. Methods Four patients who underwent intra vas device （IVD） implantation 4-10 years ago.The ptients received surgical exploration and resection of 2.5-5.5cm long segment of vas deferens of vas deferens, end to end anastomosis; 2 cases of resection of segment of vas deferens were collected for pathological examination; Semen analysis of the patients was frequently detected during follow-up. Results 1 years follow-up results were as follows： （1） recanalization results： only 1 cases （resection length within 3 cm ） had semen parameter recovery （sperm concentration 〉 20 × 10^6/mL）after operation, the other 3 cases had severe oligozoospermia and 1 cases of azoospermia semen examination after 3 months, indicating secondary anastomotic block; （2）the conception rate： 2 cases had fertility requirements, only 1 cases （semen normal） whose wife had pregnancy after 6 months later; （3） the symptoms of cholestasis： 2 cases of epididymal stasis received operation treatment, and the symptom was significant improved after surgery, and scrotal distending pain disappeared. 2 cases were diagnosed as vas deferens smooth muscle hyperplasia. Conclusion Intra vas device （IVD） has good biocompatibility and postoperative early recanalization is satisfactory.However, as a physical device cavity, long-term stimulation can result in tube wall tissue hyperplasia. Due to limitation of sample size, recanalization effect needs to be further study.