腹腔镜辅助显微输精管吻合术治疗疝修补术后梗阻性无精子症(附5例报道)

Laparoscopy-assisted vasovasostomy in the treatment of inguinal vassal obstructive azoospermia owing to inguinal hernia repair:a report of 5 cases

目的探讨腹腔镜辅助显微外科输精管吻合术治疗儿童时期双侧疝修补术后梗阻性无精子症的可行性。方法回顾分析5例患者因儿童时期行双侧腹股沟疝修补术引起医源性梗阻性无精子症的临床资料,患者年龄25~34岁,术前诊断为无精子症;儿童时期均有双侧腹股沟疝修补术史,先予以腹腔镜经腹腔探查输精管,并在其辅助下将盆段输精管自腹腔从外环引出,显微镜下与近端输精管端端吻合。结果 5例患者均在腹腔镜辅助下完成双侧输精管显微吻合术,术后随访3~15个月,5例患者在3个月时复查均未发现精子,4例患者6个月精液中检出精子,精子浓度分别为18.75×10~6/m L,25.6×10~6/m L,20.15×10~6/m L和17.84×10~6/m L,精子总活力分别为14.6%,36.3%,29.2%和15.4%。其中2例患者配偶分别于术后12个月和15个月时成功受孕。1例患者随访至今查精液仍未见精子。结论有腹股沟疝修补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,腹腔镜辅助可帮助探查找到远端输精管,从而完成输精管端端显微吻合术。

Objective To investigate the feasibility of laparoscopic assisted microsurgical vas deferens anastomosis in the treatment of bilateral hernia repair-caused obstructive azoospermia in childhood. Methods Clinical data of 5 cases with iatrogenic obstructive azoospermia caused by bilateral inguinal hernia repair were retrospectively analyzed. The patients aged 25-34 years old were all diagnosed as azoospermia preoperatively and all patients had a history of bilateral groin hernia repair in childhood. Laparoscopy was used to exploration of vas deferens first, and in its auxiliatry vesicle vas deferens from the abdominal cavity from the external inguinal ring, which under the microscope and proximal vas deferens end of anastomosis. Results Five patients underwent laparoscopic assisted microsurgery with bilateral vas deferens. Postoperative follow-up lasted 3-15 months. The spermatozoa were not found in 5 cases at 3 months after surgery. Sperm was detected in 4 patients at 6 months and the sperm concentration was 18.75×10^6/mL, 25.6×10^6/mL, 20.15×10^6/mL and 17.84×10^6/mL respectively. The sperm motility was 14.6%, 36.3%, 29.2% and 15.4% respectively. Two of the spouses were successfully conceived at 12 months and 15 months after surgery. No sperm was found in semen sample of one case until now. Conclusion Patients with azoospermia who had the history of inguinal hernia repair should avoid the possibility of iatrogenic vas deferens injury, and laparoscopic assistance can help to find distal vasdeferens, and completing the vas deferens end-to-end micro-anastomosis.