顕微鏡下精巣上体精管吻合術(side-to-end法)の経験

Abstract

精巣上体での閉塞による閉塞性無精子症10例に対し顕微鏡下精巣上体精管吻合術を行い, 9例で再開通に成功, そのうち4例で精液所見の正常化および妊娠が成立した.吻合法は精巣上体管を1本だけ剥離し, 精管と側端吻合するside-to-end法を行ったが, 他の術式に比べ手術操作は容易で手術成績も良好であった

The surgical procedures and results of microsurgical epididymovasostomy for obstructive azoospermia at the epididymis are reported. These procedures include the separation of a single epididymal tubule, an incision in the side wall, and a side-to-end anastomosis to the mucosa of the vas deferens under microscopic view. The tunica of the epididymis and the muscle layer of the vas are sutured together to support the mucosal anastomosis. Ten patients with epididymal obstruction underwent the side-to-end epididymovasostomy. The group consisted of two with Young's syndrome, one with an epididymal blow-out after vasectomy, one unsuccessful epididymoepididymostomy, 4 after epididymitis and 2 cases of unknown origin. After the operation, sperm appeared in 9 patients, and semen quality was normalized in 4 patients, all of whom impregnated their wives. Microsurgical side-to-end epididymovasostomy is a much easier procedure than Silber's specific tubule method, and results in a high success rate.