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中華民國泌尿科醫學會雜誌

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篇名 Recanalization Following Methods of Vasectomy
卷期 2:2
並列篇名 各種結紮手術後輸精管之自然再通暢
作者 勞漢信蔡崇璋江萬煊
頁次 477-482
關鍵字 Sivasectomysperm granulomarecanalizationTSCI
出刊日期 199106

中文摘要

自1973年4月起迄1990年6月底為止一十七年間,在台大醫院及台北市家庭計劃推廣中心,兩處共有6300位施行輸精管結紮手術;其中5100位(81%)備有完全的資料可據以探討,其失敗率為1.2%。此系列之失敗個案有60例,全部均用絲線結紮來封閉輸精管兩切端之管口。其中有7例,精管切除部分較短(0.5cm至1.0cm),另53例切除部分較長(1.0cm至2.0cm),同時把兩切端之精管切口附近之黏膜再加以燒灼,然後將輸精管鞘膜在兩切端之間作一層防壁。所有失敗個案中,有26例再施行手術,另34例拒絕再行手術。在重施行手術過程中,有一例為罕見先天性單側雙重精管,為先前手術時所漏紮。其他25例均發現明顯之精子肉芽腫連結於精管兩切端之間。病理組織檢查證實為單側精管之自然再通暢。有許多新生新生輸精管形成於絲線結紮附近,同在新生細管中也可發現許多精子。根據這些發現,失敗個案很可能是由於絲線導致精管結紮部位壞死,引起精液洩漏而形成精子肉芽腫;它可能腐蝕精管鞘和精管壁而引發輸精管之自然再通暢。作者調整以前所使用之結紮手術,將精管2.0cm至3.0cm切除,使兩切端之間保持較長距離;同時兩切端之輸精管不再用絲線結紮之,而改用電極針將切口附近之切口附近之黏膜燒灼而封閉管口,可防止精液洩漏,即可防止精子肉芽腫之產生。然後將輸精管的鞘膜包被遠側之輸精管切端,使兩切端之間形成一層防壁,如此可防止手術後輸精管之自然再通暢。此系列中,520個案照此方法處理之,手術後做定期精液分析檢查,並未發現有輸精管自然再通暢之現象。

英文摘要

Six thousand and three hundred vasectomies were performed under the auspices of the outpatient special clinic of National Taiwan University Hospital and the Taipei Family Planning Promotion Center, during the period from April 2, 1973 to June 30, 1990. Complete data were available for review in 5100 cases (81%). The average failure rate was 1.2%. Sixty failed cases were identified in whom ligation of both cut ends with unabsorbable silk were used. Of the 60 failed cases, 7 cases had a short vasa (0.5cm-1.0cm) resected, 53 cases had a longer vasa (1.0-2.0cm) resected, and subsequent electrofulguration of both cut ends were done, then a fascial barrier con-structed between them. Twenty six cases had been re-explored cases showed a well formed sperm granuloma in continuity with both divided ends of the vas except one (supernumerary vasa). Histopathologic examination revealed an evidence of recanaliza-tion on one side. Numerous new ductus deferenses were formed near the suture stitch previously used, and numerous sperms were also present in the lumen of newly ductus deferens. According to these findings, ligature necrosed the wall of the vas and sperm granuloma occurred, which could erode the fascia and the wall of intact vas, then re-canalization resulted was highly suspected. The author modified the operative technique, which had been used before, the vas was resected 2.0cm to 3.0cm in length and the cut ends were occluded by using electrofulguration method only, no more ligature was applied when a fascial barrier constructed between them. 520 consecutive vasectomies were performed according to those principles without failure until now. (J Urol R.O.C., 2:477-482, 1991)

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