RESULTS OF 1,469 MICROSURGICAL VASECTOMY REVERSALS BY THE VASOVASOSTOMY STUDY-GROUP
RESULTS OF 1,469 MICROSURGICAL VASECTOMY REVERSALS BY THE VASOVASOSTOMY STUDY-GROUP
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DOI：
10.1016/s0022-5347(17)38381-7
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发表时间：
1991-03-01
影响因子：
6.6
通讯作者：
SHARLIP, ID
中科院分区：
文献类型：
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作者：
BELKER, AM;THOMAS, AJ;SHARLIP, ID
在9年的时间里，在5个机构对1,469名接受显微手术输精管结扎术逆转术的男性进行了研究。 在1，247名首次接受手术的男性中，1，012名男性中有865名（86%）接受了术后精液分析，810对夫妇中有421对（52%）发生了妊娠，其中有关于受孕的信息。 通畅率（精子返回精液）和妊娠率取决于输精管切除术到其逆转的时间间隔。 如果间隔时间小于3年，通畅率为97%，妊娠率为76%，3 - 8年为88%和53%，9 - 14年为79%和44%，15年或以上为71%和30%。 两层显微手术输精管吻合术后的通畅率和妊娠率并不比改良的一层显微手术更好，并且无论外科医生如何，所有患者的通畅率和妊娠率在统计学上都相同。 当术中双侧输精管液中无精子，患者接受双侧输精管吻合术而不是输精管附睾吻合术时，83例患者中有50例（60%）通畅，65对夫妇中有20例（31%）妊娠。 输精管切除术部位是否存在精子肉芽肿以及麻醉类型都不会影响结果。 重复显微外科逆转手术不太成功。 共有222次重复手术使199例患者中的150例（75%）获得了通畅，这些患者进行了精液分析，120对夫妇中的52例（43%）报告妊娠。
During a 9-year period 1,469 men who underwent microsurgical vasectomy reversal procedures were studied at 5 institutions. Of 1,247 men who had first-time procedures sperm were present in the semen in 865 of 1,012 men (86%) who had postoperative semen analyses, and pregnancy occurred in 421 of 810 couples (52%) for whom information regarding conception was available. Rates of patency (return of sperm to the semen) and pregnancy varied depending on the interval from the vasectomy until its reversal. If the interval had been less than 3 years patency was 97% and pregnancy 76%, 3 to 8 years 88% and 53%, 9 to 14 years 79% and 44% and 15 years or more 71% and 30%. The patency and pregnancy rates were no better after 2-layer microsurgical vasovasostomy than after modified 1-layer microsurgical procedures and they were statistically the same for all patients regardless of the surgeon. When sperm were absent from the intraoperative vas fluid bilaterally and the patient underwent bilateral vasovasostomy rather than vasoepididymostomy, patency occurred in 50 of 83 patients (60%) and pregnancy in 20 of 65 couples (31%). Neither presence nor absence of a sperm granuloma at the vasectomy site nor type of anesthesia affected results. Repeat microsurgical reversal procedures were less successful. A total of 222 repeat operations produced patency in 150 of 199 patients (75%) who had semen analyses and pregnancy was reported in 52 of 120 couples (43%).