显微镜下改良单针LIVE对梗阻性无精子症患者的应用效果

Efect of Modified Single Needle LIVE under the Microscope on Patients with Obstructive Azoospermia

目的:探讨显微镜下改良单针纵向套叠输精管附睾管吻合术(LIVE)对梗阻性无精子症(OA)患者的应用效果。方法:选取2019年10月至2023年5月郑州大学第一附属医院收治的OA患者91例作为研究对象,其中45例行显微镜下改良单针LIVE患者设为改良单针组,46例行显微镜下双针LIVE患者设为双针组。对两组患者手术、住院时间、复通率、术后3、6个月两组精子前向运动总活力、精子浓度、总活力水平和配偶妊娠结果进行比较。结果:与双针组患者相比较,改良单针组的手术时间较长,差异具有统计学意义(P <0.05);两组患者的住院时间比较,差异无统计学意义(P> 0.05);术后3个月,改良单针组患者的复通率为68.88%,双针组为71.73%,组间比较,差异无统计学意义(P> 0.05);相较于术后3个月,术后6个月两组患者精子前向运动总活力、精子浓度、总活力水平均有所提高,差异均具有统计学意义(P <0.05);两组患者术后3、6个月的精子前向运动总活力、精子浓度、总活力水平比较,差异均无统计学意义(P> 0.05);术后随访6个月,改良单针组患者的配偶妊娠率为35.55%,双针组为39.13%,组间比较,差异无统计学意义(P> 0.05)。结论:显微镜下改良单针LIVE治疗OA患者与双针LIVE疗效相当,相较于双针LIVE,单针LIVE的手术时间虽稍长,但其操作简单,手术材料更易获取,因此更容易普及。

Objective To investigate the effect of modified single-needle ligation of interspermatic vas to epididymis(LIVE) under the microscope on patients with obstructive azoospermia(OA).Methods A total of 91 OA patients admitted to the First Affiliated Hospital of Zhengzhou University from October 2019 to May 2023 were selected as the subjects of this study.Among them,45 patients with improved single-needle LIVE under the microscope were set into the modified single-needle group,and 46 patients with double-needle LIVE under the microscope were set into the double-needle group.The operation,hospital stay,relapse rate,total forward sperm motility,sperm concentration,total sperm motility level and spouse pregnancy results were compared between the two groups.Results Compared with the double-needle group,the operation time of the improved single acupuncture group was longer,and the difference was statistically significant(P < 0.05).There was no significant difference in the length of hospitalization between the two groups(P > 0.05).Three months after surgery,the recurrence rate was 68.88% in the modified single-needle group and 71.73% in the double-needle group,and there was no statistical significance between groups(P > 0.05).Compared with 3 months after surgery,the total forward motility,sperm concentration and total motility level of the two groups were increased at 6 months after surgery,and the differences were statistically significant(P < 0.05).There was no significant difference in total forward motility,sperm concentration and total motility level between the two groups at 3 and 6 months after operation(P > 0.05).After 6 months of follow-up,the spouse pregnancy rate was 35.55% in the modified single-needle group and 39.13% in the double-needle group,and there was no statistical significance between groups(P > 0.05).Conclusion Modified single-needle LIVE under the microscope has the same efficacy as double-needle LIVE in the treatment of OA patients.Compared with double-needle LIVE,single-needle LIVE has a slightly longer operation time,but it is easier to operate and easier to obtain surgical materials,so it is easier to be popularized.