摘要目的 探讨双侧斜疝术后输精管道损伤相关梗阻性无精子症的手术策略.方法 回顾性分析59例有双侧斜疝手术史的梗阻性无精子症患者的临床资料.结果 根据术中探查情况行显微输精管吻合术、腹腔镜辅助的显微输精管吻合术、显微输精管附睾吻合术、交叉输精管吻合术.术中探查证实输精管损伤,伴或不伴附睾梗阻,14例无法行吻合手术,行取精手术;45例行显微重建手术,其中输精管吻合术30例,腹腔镜辅助的输精管吻合术12例,交叉输精管吻合术2例,右侧输精管附睾吻合术加左侧输精管吻合术1例.80.0％(36/45)的患者术后精液检查测到精子,31.1％(14/45)的患者术后自然妊娠.结论 双侧斜疝术后输精管损伤相关梗阻性无精子症,损伤情况多样化,手术是有效的治疗方法,可根据个体情况选择合适的治疗的方式.

abstractsObjective To investigate the strategy of operation treatment to obstructive azoospermia after bilateral inguinal hernia repair.Methods We retrospectively analyzed 59 inpatient cases of obstructive azoospermia caused by iatrogenic injury to bilateral vas deferens after bilateral inguinal hernia repair.Results Intraoperative exploration of the bilateral inguinal region was performed according to the condition of vas deferens damage and whether with epididymis obstructionin.The operations include vasovasostomy (VV),vastoepidystomy (VE),transsceptal crossover VV,and VV following laparoscopic exploration of the abdominal cavity.Among 59 patients,14 patients were performed testis sperm retreival,other 45 patients had received microscopic revascularization.Of 45 patients,30 patients were performed VV,12 patients were performed VV following combined laparoscopic exploration of the abdominal cavity,2 patients were performed transsceptal crossover VV,1 patient was performed left side VV and the right side VE.The patency rate was 80.0％ (36/45),the natural pregnant rate was 31.1％ (14/45).Conclusion For the obstructive azoospermia after bilateralinguinal hernia repair,the injury site of the vas deferens is multiform,and microsurgery is the first choice.It should choose proper type of microsurgery accoding to the concrete disease states.