Name: vessel-sparing microsurgical longitudinal intussusception vasoepididymostomy to treat epididymal obstructive azoospermia
Uploaded: 2022-05-27T14:30:00
Description: Watch this Scientific Journal Video about Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia at JoVE.com

本研究由中山大学附属第一医院东科临床研究培训项目（编号：2019002、编号：2019008）和国家卫生健康委员会中华人民共和国男性生殖与遗传学重点实验室（编号：KF202001）资助。

该研究获得中山大学第一附属医院的批准。诊断标准、手术适应证和禁忌证均符合《男科诊疗指南》和《中国男科学会》和《欧洲泌尿外科学会性健康和生殖健康指南》的专家共识。如果女性伴侣患有影响生育能力的疾病，则患者将被排除在本研究之外。
1. 操作仪器
<ol><li>确保 材料表中提到的灭菌器械和其他设备的可用性。</li>
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<ol>
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A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Vasovasostomy+and+vasoepididymostomy:+indications,+operative+technique,+and+outcomes.">Vasovasostomy and vasoepididymostomy: indications, operative technique, and outcomes.</a> Fertility and Sterility. 115 (6), 1384-1392 (2021).</li><li>Baker, K., Jr, S. a. b. a. n. e. g. h. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Obstructive+azoospermia:+reconstructive+techniques+and+results.">Obstructive azoospermia: reconstructive techniques and results.</a> Clinics. 68, 61-73 (2013).</li><li>Monoski, M. A., Schiff, J., Li, P. S., Chan, P. T., Goldstein, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Innovative+single-armed+suture+technique+for+microsurgical+vasoepididymostomy.">Innovative single-armed suture technique for microsurgical vasoepididymostomy.</a> Urology. 69 (4), 800-804 (2007).</li><li>Zhao, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+modified+single-armed+technique+for+microsurgical+vasoepididymostomy.">A modified single-armed technique for microsurgical vasoepididymostomy.</a> Asian Journal of Andrology. 15 (1), 79-82 (2013).</li><li>Zhao, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Retrospective+analysis+of+early+outcomes+after+a+single-armed+suture+technique+for+microsurgical+intussusception+vasoepididymostomy.">Retrospective analysis of early outcomes after a single-armed suture technique for microsurgical intussusception vasoepididymostomy.</a> Andrology. 3 (6), 1150-1153 (2015).</li><li>Harrison, R. 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泌尿生殖道感染和附睾炎是附睾OA的常见原因。VE已成为治疗附睾OA的重要方法，自2000年以来已在临床上应用4。输精管和附睾的吻合术是用双针缝合线进行的，在经典的MVE6，8，9中不保留输精管的血管。由于双针缝合线价格昂贵且不易获得，且我国大多数患者的病因与西方国家不同，因此提出了血管保存技术?...

不孕夫妇的人数每年都在增加。OA发生在20%-40%的育龄男性无精子症病例中1。附睾梗阻约占OA病例的30%，是最常见的梗阻部位之一。然而，这一比例在中国可能更高2，3。OA的治疗因梗阻部位而异。OA 的常见病因包括输精管切除术、泌尿生殖道感染、泌尿生殖系统结核、医源性损伤和特发性梗阻。在中国，OA的病因多为泌尿生殖道感染或附睾炎引起的附睾梗阻，而输精管切除术是西方国家最常见的病因2，3。这两种类型的梗阻需要略有不同的手术方法。
显微外科血管表雄腺造口术（MVE）自2000年以来已成为治疗附睾OA的重要方法4。MVE是男性显微外科手术中最具挑战性的手术，包括显微外科端到端单肾小管吻合术、端到端吻合口术、三角测量、肾小管内陷术和肾小管肠套叠技术5.纵向肠套叠血管表切开术（LIVE）更有利，因为附睾小管6，7，8的开口更宽。基于本案在中国的特点，提出了一种基于改进的单臂缝合MVE技术，改进的、保留船舶的、改良的单臂缝合LIVE技术。该技术不仅可以在不易获得双针缝合的区域进行血管表皮环切术（VE），还可以保留输精管的脉管系统并维持正常的生理结构。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>0.9% sodium chloride solution</td>
			<td>Guangdong Otsuka Pharmaceutical Co. LTD</td>
			<td>21M1204</td>
			<td>Dilute antibiotics, irrigate.</td>
		</tr>
		<tr>
			<td>1 mL syringe</td>
			<td>Kindly Medical, Shanghai</td>
			<td>K20210826</td>
			<td>inject diluted methylene blue or 0.9% sodium chloride solution</td>
		</tr>
		<tr>
			<td>1% iodophor</td>
			<td>Guangzhou Qingfeng Disinfection Products Co., LTD</td>
			<td>Q/QFXD2</td>
			<td>Disinfect the surgical area.</td>
		</tr>
		<tr>
			<td>10-0 polypropylene sutures</td>
			<td>Ethicon, LLC</td>
			<td>REBBES</td>
			<td>Used when anastomosing.</td>
		</tr>
		<tr>
			<td>3-0 polyglactin 910 sutures</td>
			<td>Ethicon, LLC</td>
			<td>RGMCLH</td>
			<td>Suture skin incisions at the end of surgery.</td>
		</tr>
		<tr>
			<td>5-0 polyglactin 910 sutures</td>
			<td>Ethicon, LLC</td>
			<td>RBMMPQ</td>
			<td>Suture skin incisions at the end of surgery.</td>
		</tr>
		<tr>
			<td>8-0 polypropylene sutures</td>
			<td>Ethicon, LLC</td>
			<td>RDBBLS</td>
			<td>Used when anastomosing.</td>
		</tr>
		<tr>
			<td>9-0 polypropylene sutures</td>
			<td>Ethicon, LLC</td>
			<td>RABDTE</td>
			<td>Used when anastomosing.</td>
		</tr>
		<tr>
			<td>F16 urinary catheter</td>
			<td>Well Lead Medical, Guangzhou</td>
			<td>20190612</td>
			<td>Drainage of urine due to long operation time.</td>
		</tr>
		<tr>
			<td>micro haemostatic forceps</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>W40350</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro scissors</td>
			<td>Cheng-He,NingBo</td>
			<td>HC-A008</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro tweezers</td>
			<td>Cheng-He,NingBo</td>
			<td>HC-A002</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>microneedle holder</td>
			<td>Cheng-He,NingBo</td>
			<td>HC-GN006</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>ophthalmic scissors</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>Y00040</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>polyglactin 910 sutures</td>
			<td>Ethicon, LLC</td>
			<td>RBMMPQ</td>
			<td>Suture skin incisions at the end of surgery.</td>
		</tr>
		<tr>
			<td>silk braided non-absorbable suture</td>
			<td>Ethicon, LLC</td>
			<td>SB84G</td>
			<td>ligate the broken end of the vas deferens</td>
		</tr>
		<tr>
			<td>skin marker</td>
			<td>Medplus Inc.</td>
			<td>21120206</td>
			<td>Mark surgical incisions and suture sites.</td>
		</tr>
		<tr>
			<td>surgical microscope Carl Zeiss S88</td>
			<td>Carl Zeiss</td>
			<td>Carl Zeiss S88</td>
			<td>Enlarge your field of vision during surgery.</td>
		</tr>
		<tr>
			<td>vas-fixation clamp</td>
			<td>Shanghai Surgical Instrument Factory</td>
			<td>JCZ220</td>
			<td>Used in surgical procedures</td>
		</tr>
	</tbody>
</table>

vessel-sparing microsurgical longitudinal intussusception vasoepididymostomy to treat epididymal obstructive azoospermia

附睾是梗阻性无精子症 （OA） 中梗阻的常见部位。自2000年以来，血管顶端骨造口术已成为治疗附睾OA的重要方法。经典的显微镜血管顶端切开术有两个挑战。首先，用双针缝合线进行输精管和附睾的吻合术。然而，中国缺乏高质量和具有成本效益的双针缝合线，这导致吻合术的难度增加和成功率低。其次，输精管的分离不会保留输精管系统，尽管输精管输精管在输精管、附睾和睾丸的血液供应中起着重要作用。这会影响吻合口区域和附睾的血液供应。
因此，该团队进行了创新的改进来解决这些问题。质量好、性价比高的单针缝合线，在中国等国家容易购买，用于显微外科纵向肠套叠血管表脑造口术。这样可以优化手术程序，缩短手术时间，同时保证吻合的成功率。创新性地提出了保留输精管血管的手术方法，因为附睾OA的病因在中国主要是炎症性的。使用显微外科镊子分离和保护脉管系统，最大限度地保护输精管和附睾的血液供应。术后随访通畅率达到81.7%，表明手术治疗效果较好。

一项研究纳入了92名在中国广州中山大学附属医院被诊断患有继发于附睾梗阻的无精子症的男性，他们在2017年1月至2018年12月期间接受了手术。92名男性的平均年龄为30.77±5.38岁（范围：20-47岁）（表1）。所有男性均接受了双侧容器保留，改进，单臂技术进行LIVE，平均手术时间为223.59±31.73 min。未发现术后并发症或严重不良事件。建立了定期随访计划，在术后6周进行第一次精液分析，?...

Watch this Scientific Journal Video about Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia at JoVE.com

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

本方案描述了一种保留血管的纵向肠套叠血管表皮造口术，使用现成的单针缝合线在中国，这是一种安全有效的手术，可以改善患者的通畅性和自然妊娠率。

血管保留性显微外科纵向套叠血管表皮造口术治疗附睾梗阻性无精子症

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of ...

该方案能够使用现成的单针缝合线成功吻合。它可以通过保留输精管血管来改善患者的通畅性和自然妊娠率。这种技术的单针缝合线在大多数国家都很容易获得。保留输精管可保护吻合口性口造口和附睾的血液供应。而且它更符合生理结构。该技术适用于附睾梗阻性无精子症和输精管切除术，不会损害输精管的输精管系统，并且需要专门的显微外科培训。视觉演示对于此过程非常重要，因为它使此技术更易于理解和学习。首先将16法式Foley导管插入尿道，并用皮肤标记标记切口部位。做一个三到四厘米的垂直阴囊切口，并通过切口输送睾丸。使用输精管固定钳，将输精管暴露在睾丸附近的精索旁边。将血管吊带穿过输精管和输精管输精管系统之间的空间。对血管吊带施加牵引力。在手术显微镜下，用微止血镊子分离结缔组织并用电刀切割，然后用微止血镊子小心地将差分血管与输精管一厘米分离。输精管。然后通过用连接到一毫升注射器的24号冲洗针头注射稀释的亚甲基蓝并观察尿液中的染料来确认其通畅性。或者，注入0.9%氯化钠溶液，无阻力或回流。用微型止血镊子分离阴道和睾丸之间的粘连，并在打开束腰阴道后用电刀切割。在手术显微镜下检查附睾，并选择扩张的附睾小管的部位进行吻合。使用眼科剪刀，切下一块直径五毫米的附睾外衣。用刀完全切开输精管，并用丝编织的不可吸收缝合线将附睾附近的断裂末端连接起来。使用止血镊子穿孔阴道，并通过输精管的孤立部分通过隧道到达吻合口部位。修复输精管和附睾外衣使用两个中断的8-0聚丙烯缝合线。确保输精管没有扭曲。使用显微镜双极凝固来阻止输精管出血，以保持手术区域清晰。在输精管上标记四个等距缝合点后，使用两个单臂10-0聚丙烯缝合线进行这种改良的单臂缝合技术。使用微针支架，将两根针分别穿过血管粘膜层的下部，并以稍微扩张血管腔的方式向外穿刺。在显微镜下精确控制针头，避免将针头钩入管腔的后壁。将两根针平行纵向移动，穿过同一附睾小管。使用15度的眼科刀，将两根针放入两根针之间纵向打开的附睾小管中。用连接到一毫升注射器的24号冲洗针头抽吸从小管切口流出的附睾液体。将其交给考官检查精子。分别轻轻地拔出附睾小管中的两根针，并以由内而外的方式将它们穿过血管粘膜层的上部。用8-0缝合附睾外衣中输精管的外膜聚丙烯缝合线，用于在附睾小管进入输精管进行肠套叠之前降低张力。使用10至12个中断的9-0聚丙烯缝合线缝合输精管的肌肉边缘和附睾外衣。这项研究包括92名年龄在20至47岁之间的男性。所有男子都接受了双侧船只备用改装的单臂技术进行现场直播。平均操作时间约为224分钟。未发现术后并发症或严重不良反应。建立了定期随访计划，在手术后六周进行第一次精液分析，然后每三个月进行一次检查。通畅率为81.7%，平均通畅时间约为4.64个月。精液在第一次通畅时显示少精子症或弱精子症。配偶的平均年龄从20岁到46岁不等。这些配偶中没有一个患有任何影响其生育能力的疾病。自然妊娠率为35.8%，在一次妊娠中使用睾丸抽吸获得精子的体外受精。其余29名患者的伴侣自然怀孕，86.2%的患者在手术后12个月内怀孕。该过程最重要的部分是避免将针头钩入输精管腔的后壁，并保持吻合口无张力。关键步骤包括容器分离和现场表演。男科医生可以使用该技术来开发更好的梗阻性无精子症治疗方法，使手术更安全，更有效。

Research

JoVE Journal

Medicine

The Helsinki Rat Microsurgical Sidewall Aneurysm Model

赫尔辛基鼠显微旁瘤模型

Experimental saccular aneurysm models are necessary for testing novel surgical and endovascular treatment options and devices before they are introduced ...

科研

医学

A Novel Microsurgical Model for Heterotopic, En Bloc Chest Wall, Thymus, and Heart Transplantation in Mice

一种新的显微模型异位，整块胸壁，胸腺，和心脏移植小鼠

Exploration of novel strategies in organ transplantation to prolong allograft survival and minimizing the need for long-term maintenance immunosuppression ...

Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases

Longitudinal In Vivo Imaging of the Cerebrovasculature: Relevance to CNS Diseases

纵<em&gt;在体内</em&gt;的Cerebrovasculature影像：相关性疾病CNS

Remodeling of the brain vasculature is a common trait of brain pathologies. In vivo imaging techniques are fundamental to detect cerebrovascular ...

Development of Recombinant Proteins to Treat Chronic Pain

重组蛋白治疗慢性疼痛的研究进展

Chronic pain is difficult to treat and new approaches to resolve persistent pain are urgently needed. Anti-inflammatory cytokines are promising candidates ...

Vessel-sparing Excision and Primary Anastomosis

血管保留切除术与原发性吻合术

Urethroplasty is considered to be the standard treatment for urethral strictures since it provides excellent long-term success rates. For isolated short ...

A Minimally Invasive Method for Intratracheal Instillation of Drugs in Neonatal Rodents to Treat Lung Disease

一种新生儿啮齿动物气管内滴注药物治疗肺部疾病的微创方法

Treatment of neonatal rodent with drugs instilled directly into the trachea could serve as a valuable tool to study the impact of a locally administered ...

Fat-Covered Islet Transplantation Using Epididymal White Adipose Tissue

使用附睾白色脂肪组织进行脂肪覆盖的胰岛移植

Islet transplantation is a cellular replacement therapy for severe diabetes mellitus. The intraperitoneal cavity is typically the transplant site for this ...

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

一种改良的血管保留显微外科血管附睾造口术

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, ...

Exploring the Two Herb Combination Strategy to Treat Injured PC12 Cells

探索两种草药组合策略治疗受损PC12细胞

In view of the advantages of the combination of traditional Chinese medicine (TCM) in the treatment of cerebral ischemia, we studied the differences in ...

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

显微镜囊肿切除术治疗诊断为附睾囊肿的患者

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...