显微镜下单针法纵向套叠输精管附睾吻合术后附睾管-输精管精道复通的影响因素

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Influencing factors of postoperative patency of longitudinal single suture intussusception microsurgical vasoepididymostomy

ABSTRACT：Objective To analyze the influencing factors of postoperative patency of longitudinal single suture intussusception microsurgical vasoepididymostomy，to provide reference for improving the repetition rate.Methods The clinical data of 82 patients with epididymal obstructive azoospermia who underwent longitudinal single suture intussusception microsurgical vasoepididymostomy in our hospital during Sep.2020 and Jan.2023 were retrospectively analyzed.The postoperative patency and spouse pregnancy were followed up by face to face and / or telephone interview.The effects of age，course of disease，body mass index （BMI），previous medical history （epididymitis，operation history，none），preoperative seminal plasma elastase （SPE） level，anastomosis site，unilateral and bilateral lesion，sperm quality，operation time and hospital stay on the postoperative patency rate were analyzed.Results All operations were successful，the follow-up rate was 95.12% （78/82），78 were married，and the postoperative patency was 78.21% （61/78）.Of the 61 patients who achieved patency，56 were married，and the natural pregnancy rate of spouse was 45.21% （33/73）.Univariate analysis showed that patients with age <30 years，course of disease <2 years，preoperative SPE level <290 ng/mL，bilateral anastomosis，body or tail anastomosis and motile sperm had higher postoperative patency rate （P＞0.05）.BMI，previous history，the number of motile sperms examined by epididymal fluid，the length of operation and hospital stay had no significant effects on postoperative patency （P＞0.05）.The results of multivariate logistic regression analysis showed that preoperative SPE level （OR=0.998，95%CI：0.997-1.000，P=0.008） and （OR=10.724，95%CI：2.243-51.283，P=0.003） were significantly correlated with postoperative patency.Conclusion The preoperative SPE level and anastomosis site are significant influencing factors of postoperative patency，which is higher in patients with age <30 years，course of disease <2 years，preoperative SPE level <290 ng/mL，bilateral anastomosis，body or tail anastomosis and motile sperm.

KEY WORDS：microsurgical vasoepididymostomy; obstructive azoospermia; epididymal obstruction; influencing factors; male infertility；seminal plasma elastase

摘要：目的 分析显微镜下单针法纵向套叠输精管附睾吻合术治疗附睾梗阻性无精子症术后附睾管-输精管精道复通的影响因素，为临床提高复通率提供参考。（剩余7168字）