Name: clinical application of 24 g cannula needle and 3-0 polypropylene suture in vas deferens exploration
Uploaded: 2023-02-10T14:55:00
Description: Watch this Scientific Journal Video about Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration at JoVE.com

我们感谢ZHZ对这项研究的构思和设计。JW和YPZ执行并监督了手术。YH，YBX，SL为数据分析做出了贡献。JW和WJL准备了视频的草稿。所有作者都参与了手稿的修订。所有作者都阅读并批准了最终手稿。

此处描述的所有方法均由华中科技大学同济医学院协和医院伦理委员会批准。我们征得了患者的同意，在手术后将他的手术录像用作视频。
1. 操作仪器
<ol><li>确保手术显微镜系统、显微手术器械和显微双极电凝术的可用性。</li>
</ol>2. 操作准备
<ol><li>入选标准<ol><li>包括所有被诊断为同意接受手术的无精子症患者。让患者的所有?...

<ol>
	<li>Chen, X. F., 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=Clinical+features+and+therapeutic+strategies+of+obstructive+azoospermia+in+patients+treated+by+bilateral+inguinal+hernia+repair+in+childhood.">Clinical features and therapeutic strategies of obstructive azoospermia in patients treated by bilateral inguinal hernia repair in childhood.</a> Asian Journal of Andrology. 16 (5), 745-748 (2014).</li><li>Sparkman, R. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+exploration+in+inguinal+hernia+in+juvenile+patients.+Review+and+appraisal.">Bilateral exploration in inguinal hernia in juvenile patients. Review and appraisal.</a> Surgery. 51, 393-406 (1962).</li><li>Pollak, R., Nyhus, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+groin+hernia+repair.">Complications of groin hernia repair.</a> The Surgical Clinics of North America. 63 (6), 1363-1371 (1983).</li><li>Sheynkin, Y. R., Hendin, B. N., Schlegel, P. N., 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=Microsurgical+repair+of+iatrogenic+injury+to+the+vas+deferens.">Microsurgical repair of iatrogenic injury to the vas deferens.</a> The Journal of Urology. 159 (1), 139-141 (1998).</li><li>Wang, J., 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=Treatment+for+Vas+Deferens+Obstruction+Following+Childhood+Herniorrhaphy.">Treatment for Vas Deferens Obstruction Following Childhood Herniorrhaphy.</a> Urology. 112 (1), 80-84 (2018).</li><li>Smith, R. P., 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=The+significance+of+sperm+heads+and+tails+within+the+vasal+fluid+during+vasectomy+reversal.">The significance of sperm heads and tails within the vasal fluid during vasectomy reversal.</a> Indian Journal of Urology. 30 (2), 164-168 (2014).</li><li>Jungwirth, A., Diemer, T., Kopa, Z., Krausz, C., Tournaye, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=European+Association+of+Urology+guidelines+on+male+infertility.+2017+edition.">European Association of Urology guidelines on male infertility. 2017 edition.</a> , 23-24 (2017).</li><li>Bromage, S. J., Falconer, D. A., Lieberman, B. A., Sangar, V., Payne, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sperm+retrieval+rates+in+subgroups+of+primary+azoospermic+males.">Sperm retrieval rates in subgroups of primary azoospermic males.</a> European Urology. 51 (2), 539-540 (2007).</li><li>Du, J., 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=Differential+diagnosis+of+azoospermia+and+etiologic+classification+of+obstructive+azoospermia:+role+of+scrotal+and+transrectal+US.">Differential diagnosis of azoospermia and etiologic classification of obstructive azoospermia: role of scrotal and transrectal US.</a> Radiology. 256 (2), 493-503 (2010).</li><li>Pasqualotto, F. F., Pasqualotto, E. B., Agarwal, A., Thomas Jr, A. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Results+of+microsurgical+anastomosis+in+men+with+seminal+tract+obstruction+due+to+inguinal+herniorrhaphy.">Results of microsurgical anastomosis in men with seminal tract obstruction due to inguinal herniorrhaphy.</a> Revista do Hospital das Clinicas. 58 (6), 305-309 (2003).</li><li>Shaeer, O. K. Z., Shaeer, K. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopy-assisted+pelvi-scrotal+vasovasostomy.">Laparoscopy-assisted pelvi-scrotal vasovasostomy.</a> Andrologia. 36 (5), 311-314 (2004).</li></ol>

如前所述，输精管残端的位置无法在腹股沟切口处确定，这需要探索原始腹股沟切口。在这项研究中，我们可以使用这种简单的操作来确定梗阻部位并做出手术决策。如果梗阻部位在原始切口中，可以考虑MVV。如果在腹股沟管中未发现输精管损伤，我们可以使用lapa-VV或SV。
当发现没有精子的糊状液体并且输精管的阻塞比原始切口高2厘米时，停止手术并缝合切口。然而，由于?...

显微外科血管造瘘术 （MVV） 是儿童1，2 疝后输精管梗阻的常用治疗方法。术前无法确定梗阻部位，也不清楚输精管中是否存在精子。这可能导致半开放探查时输精管切口选择困难和损伤，降低吻合成功率，延长手术时间，增加腹部探查风险3，4。
腹股沟管输精管损伤可能是儿童期腹股沟疝手术的后遗症，通常可由结扎、切口或过度拉伸引起1.儿童期疝后无精子症的发生率在儿童患者中约为0.8%-2.0%。然而，在不孕人群中，医源性梗阻的发生率显着增加，在7.2%的男科手术中存在输精管损伤史2，3。通常对腹股沟区域进行手术探查，以寻找输精管残留物以进行吻合4。在以前的病例中，在腹股沟探查期间通常不会发现输精管末端破裂，这导致手术终止并增加对患者的手术创伤。因此，使用简单的方法确定梗阻的位置以明确以下外科手术非常重要。 
在这项研究中，使用24 G套管刺穿输精管以确认其中是否存在精子，并通过套管进行3-0聚丙烯缝合以确定阻塞部位的位置。基于这个简单的操作，我们可以确定下一个外科手术。在实践和总结临床操作之后，我们具体的手术方法如下。

<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>&#160;21M1204&#160;</td>
			<td>Inject into the vas deferens</td>
		</tr>
		<tr>
			<td>1% iodophor</td>
			<td>Guangzhou Qingfeng Disinfection Products Co., LTD&#160;</td>
			<td>Q/QFXD2</td>
			<td>Skin disinfection</td>
		</tr>
		<tr>
			<td>24G cannula needle</td>
			<td>Suzhou Linhua Medical Instrument Co., LTD</td>
			<td>20193141896</td>
			<td>Size:24G, Type:Pen type, with wings, with injection port, Y type</td>
		</tr>
		<tr>
			<td>3-0 monofilament polypropylene</td>
			<td>Covidien Medical Equipment international trading (Shanghai) Co., LTD</td>
			<td>DOL2861y</td>
			<td>Taper Point, Size 3-0, Blue, 36&#34;, Needle V-20, 1/2 Circle</td>
		</tr>
		<tr>
			<td>5 mL syringe</td>
			<td>&#160;Kindly Medical, Shanghai</td>
			<td>&#160;K20210826</td>
			<td>Inject 0.9% sodium chloride solution into the vas deferens</td>
		</tr>
		<tr>
			<td>F16 Catheter</td>
			<td>&#160;Guangzhou Weili Co., Ltd&#160;</td>
			<td>20190612</td>
			<td>Drainage of urine</td>
		</tr>
		<tr>
			<td>micro haemostatic forceps</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>W40350</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro scissors</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>WA1010</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>micro tweezers</td>
			<td>Shanghai Medical Instrument (Group) Co., LTD.</td>
			<td>WA1020</td>
			<td>Used in surgical procedures</td>
		</tr>
		<tr>
			<td>Olympus microscope</td>
			<td>Olympus Corporation</td>
			<td>Scipu001158</td>
			<td>4&#215;N.A.0.10 W.D.22.0mm&#160;&#160;&#160;&#160; 10&#215;N.A.0.25 W.D.10.5mm&#160;&#160;&#160;&#160;&#160;&#160; 40&#215;N.A.0.65 W.D.0.56mm&#160;&#160;&#160;&#160; 100&#215;N.A.1.25 W.D.0.13mm&#160;</td>
		</tr>
		<tr>
			<td>Operating microscope system</td>
			<td>&#160;Carl Zeiss Co., Ltd&#160;</td>
			<td>OPMI VARIO 700</td>
			<td></td>
		</tr>
	</tbody>
</table>

clinical application of 24 g cannula needle and 3-0 polypropylene suture in vas deferens exploration

本文的目的是介绍24 G套管和3-0聚丙烯缝合线的应用，作为探索输精管的简单方法。在探索输精管期间，使用24 G套管针刺穿它。涂片中的液体证实了精子的存在，以确定附睾和输精管的连接处是否存在伴随的阻塞。然后，将3-0聚丙烯缝合线（该缝合线规格具有表面光滑，质量坚固，并且可以通过24 G套管针穿过）穿过套管针以探测阻塞部位的位置。使用这种技术，对输精管的探索可以更有针对性和准确性。

有67名患者参加了这项研究。如表1所示，患者的平均年龄为28.8岁±3.7岁（范围：23-45岁）。自疝气以来的时间是24.5±3.2年（范围：21-43年）。女性伴侣年龄分别为25.2岁±3.2岁（范围：23-42岁）。共有11例（16.4%）患者阴囊疼痛。四名患者（6.0%）体重不足（BMI < 18.5 kg/m 2），53 名（79.1%）体重正常（BMI 18.5-24.9 kg/m 2），八名（11.9%）超重（BMI 25-29.9 kg/m 2），两名（3.0%）肥胖（BMI > 30 k...

Watch this Scientific Journal Video about Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration at JoVE.com

Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration

该协议介绍了24G套管和3-0聚丙烯缝合线的临床应用，作为探索输精管的简单有效的方法。

24 g套管针和3-0聚丙烯缝合线在输精管勘探中的临床应用

The goal of this article is to present the application of a 24 G cannula and 3-0 polypropylene suture as a simple method for the exploration of the vas ...

显微外科血管造瘘术是儿童疝气后输精管梗阻的常用治疗方法。手术探查前难以预测梗阻部位的位置，不清楚输精管内是否有精子，这可能导致半开放探查导致切口选择困难和输精管损伤，降低吻合成功率，延长手术时间，增加腹部探查风险。在以前的病例中，在腹股沟探查期间通常不会发现输精管末端破裂，导致手术中断并增加患者的手术创伤。因此，如何用简单的方法确定梗阻部位，以便明确接下来的外科手术非常重要。经过实践和临床操作总结，我们具体操作措施介绍如下。手术程序。麻醉后，我们对仰卧位的患者进行了标准消毒。我们沿着阴囊的中间褶皱做了一个三厘米的切口。然后我们刺穿了一个睾丸，切开肉膜，露出睾丸鞘和精索。我们沿着输精管脉管系统和精索脉管系统之间的空间分开。然后我们用组织钳固定输精管，并准备进行膀胱穿刺术。我们沿输精管纵轴斜向下插入24G套管针15度，在明显的触觉突破后拔出针芯，并将较软的穿刺器推到腔内。经精管鉴定后，用2ml生理盐水推入24G套管针，确认用生理盐水阻塞的输精管近端无法推入。输精管涂片检查中的液体可以确认精子的存在，以确认输精管和附睾的连接处是否存在同时阻塞。之后，3-0 Prolene缝合线通过套管针头探查阻塞部位的位置。我们的研究将梗阻部位分为三组。第一，输精管阻塞位于原始疝修补的切口处。第二，输精管阻塞位置比原始切口高两厘米。第三，输精管梗阻距离上缘原始切口超过五厘米。这项技术可以使输精管的探索更有目的性和准确性。具有代表性的结果。共有67名患者参加了这项研究。如表一所示，患者年龄从23岁到45岁不等。自疝气以来的时间从21岁到43年不等。女性伴侣的平均年龄从23岁到42岁不等。11例患者出现阴囊疼痛。4名患者体重不足，53名正常，8名超重，2名肥胖。输精管梗阻部位，根据手术方式导致不同亚组，见表二。涂片检查显示，25例套管针液中无精子，其中3例行双侧VV，梗阻部位位于原切口，通畅率为33.3%22例ART行，输精管梗阻位置比原切口上缘高2厘米。涂片检查确定42例插管针液中存在精子，其中29例接受双侧VV，其中梗阻部位位于原切口，通畅率为79.3%然后接受Lapa-VV，其中梗阻部位位置比原切口高2厘米，通畅率为40%3例行SV，其中梗阻部位位置比原切口高5厘米切口和通畅率分别为33.3%的结论和讨论。在我们的研究中，探索过程中有几种可能性。第一，如果涂片检查确定套管针液中不存在精子，则输精管和附睾的连接处可能同时存在阻塞。如果输精管阻塞的位置比原始切口的上缘高出两厘米，由Prolene缝合线探测，则可以考虑直接接受辅助生殖技术。如果梗阻部位位于原始切口，则可以考虑进行MVE MVV。第二，如果涂片检查确定精子存在于套管针液中，而3-0 Prolene缝合检测阻塞位于原始疝修补的切口处，则可以直接探索原始腹股沟切口。第三，如果涂片检查确定插管针液中存在精子，而 3-0 Prolene 缝合检测阻塞距离上边缘原始切口不到 2 厘米，则可以考虑腹腔镜辅助输精管探查，并且可以从腹股沟外环中拔出近端输精管以进行吻合。第四，如果涂片检查确定精子存在于套管针液中，而 3-0 Prolene 缝合线检测到阻塞距离上边缘原始切口超过 5 厘米，则可能存在精囊发育不良或射精管阻塞。结合术前精液量和精囊MRI，可考虑精囊内镜探查。24G套管针和3-0脲缝合操作简单，对输精管损伤小，优化了手术流程，增加了手术决策的强度，为患者利益最大化提供了一种简单有效的方法。

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