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CLC number: R699.8

On-line Access: 2019-03-01

Received: 2018-05-29

Revision Accepted: 2018-12-19

Crosschecked: 2019-01-10

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Citations:  Bibtex RefMan EndNote GB/T7714

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Journal of Zhejiang University SCIENCE B 2019 Vol.20 No.3 P.282-286

http://doi.org/10.1631/jzus.B1800303


Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia


Author(s):  Zhong-Yan Liang, Feng-Bin Zhang, Le-Jun Li, Jing-Ping Li, Jing-Gen Wu, Chong Chen, Yi-Min Zhu

Affiliation(s):  Department of Reproductive Endocrinology, Reproductive Medicine Center, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China; more

Corresponding email(s):   zhuyim@zju.edu.cn

Key Words:  Vasovasostomy, Azoospermia, Microsurgery


Zhong-Yan Liang, Feng-Bin Zhang, Le-Jun Li, Jing-Ping Li, Jing-Gen Wu, Chong Chen, Yi-Min Zhu. Clinical application of cross microsurgical vasovasostomy in scrotum for atypical obstructive azoospermia[J]. Journal of Zhejiang University Science B, 2019, 20(3): 282-286.

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author="Zhong-Yan Liang, Feng-Bin Zhang, Le-Jun Li, Jing-Ping Li, Jing-Gen Wu, Chong Chen, Yi-Min Zhu",
journal="Journal of Zhejiang University Science B",
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number="3",
pages="282-286",
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publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1800303"
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A1 - Feng-Bin Zhang
A1 - Le-Jun Li
A1 - Jing-Ping Li
A1 - Jing-Gen Wu
A1 - Chong Chen
A1 - Yi-Min Zhu
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DOI - 10.1631/jzus.B1800303


Abstract: 
Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.

阴囊内输精管交叉显微吻合手术在不典型梗阻性无精子症患者中的临床应用

目的:探讨在不典型梗阻性无精子症患者中施行不同方式阴囊内输精管交叉显微吻合手术的指征及有效性.
创新点:分析不同方式阴囊内输精管交叉显微吻合手术的指征及有效性,建议使用损伤小且成功率较高的阴囊内单纯输精管交叉显微吻合手术方式.
方法:收集2012年1月至2016年6月浙江大学医学院附属妇产科医院68例不典型梗阻性无精子症和9例重度少弱精子症患者的临床资料,对施行不同手术方式的患者的特征、术后精子参数和配偶自然妊娠率结果等相关数据进行分析.
结论:不典型梗阻性无精子症患者中施行各种类型的输精管交叉吻合手术均是对传统原位吻合手术有益的补充,阴囊内单纯输精管交叉显微吻合手术损伤小且成功率较高.

关键词:输精管吻合;无精子症;显微手术

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

Reference

[1]Chan PT, 2013. The evolution and refinement of vasoepididymostomy techniques. Asian J Androl, 15(1):49-55.

[2]Chen XF, Wang HX, Liu YD, et al., 2014. Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood. Asian J Androl, 16(5):745-748.

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[9]Nordhoff V, Fricke RK, Schüring AN, et al., 2015. Treatment strategies for severe oligoasthenoteratozoospermia (OAT) (<0.1 million/mL) patients. Andrology, 3(5):856-863.

[10]Peng J, Zhang ZC, Yuan YM, et al., 2017. Pregnancy and live birth rates after microsurgical vasoepididymostomy for azoospermic patients with epididymal obstruction. Hum Reprod, 32(2):284-289.

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