CAJ | 학술논문

目的：研究梗阻性无精子症动物模型的制作方法,比较不同显微外科吻合技术的优缺点。方法将20只6周龄雄性SD大鼠随机分成5组，包括假手术组、对照组、双针纵向输精管附睾套叠式吻合（VE）组、单针VE组、逆向单针VE组。除了假手术组外，各组大鼠都行近附睾端双侧输精管结扎术，制作梗阻性无精子症的动物模型；2周后分别行双针VE、单针VE、逆向单针VE，对照组只行输精管结扎术，假手术组我们把睾丸移出腹腔后再移回原位。12周后处死大鼠，检测吻合口和输精管结扎处精子肉芽肿形成情况，从输精管的腹腔端向附睾注射美兰，检测吻合口的机械再通率。结果双针VE组，单针VE组，逆向单针VE组的机械再通率分别是100%、75%、87.5%，精子肉芽肿的形成率分别是12.5%、12.5%、12.5%，平均手术时间是（38.1±4.3）min、（42.3±2.9）min、（41.0±3.3） min。结论双侧近附睾端输精管结扎制作梗阻性无精子症动物模型的方法简单、可靠，适用于显微VE技术训练。单针法VE可以获得双针VE法相同的疗效，节约手术成本，在缺少双针缝线时不失为实用、有效的替代手术方法，逆向单针VE术能降低误缝输精管对侧粘膜的概率。
목적：연구경조성무정자증동물모형적제작방법,비교불동현미외과문합기술적우결점。방법장20지6주령웅성SD대서수궤분성5조，포괄가수술조、대조조、쌍침종향수정관부고투첩식문합（VE）조、단침VE조、역향단침VE조。제료가수술조외，각조대서도행근부고단쌍측수정관결찰술，제작경조성무정자증적동물모형；2주후분별행쌍침VE、단침VE、역향단침VE，대조조지행수정관결찰술，가수술조아문파고환이출복강후재이회원위。12주후처사대서，검측문합구화수정관결찰처정자육아종형성정황，종수정관적복강단향부고주사미란，검측문합구적궤계재통솔。결과쌍침VE조，단침VE조，역향단침VE조적궤계재통솔분별시100%、75%、87.5%，정자육아종적형성솔분별시12.5%、12.5%、12.5%，평균수술시간시（38.1±4.3）min、（42.3±2.9）min、（41.0±3.3） min。결론쌍측근부고단수정관결찰제작경조성무정자증동물모형적방법간단、가고，괄용우현미VE기술훈련。단침법VE가이획득쌍침VE법상동적료효，절약수술성본，재결소쌍침봉선시불실위실용、유효적체대수술방법，역향단침VE술능강저오봉수정관대측점막적개솔。
Objective To study the method of making of obstructive azoospermia(OA) animal model, and compare the advantages and disadvantages of different microsurgical anastomosis. Methods Total of 20 male SD rats (6-week-old) were randomly divided into 5 groups, including the sham operation group, the control group, the standard double-armed longitudinal intussusception vasoepididymostomy(VE) group, the single-armed and reverse single-armed longitudinal intussusception vasoepididymostomy groups. All rats except those in the sham operation group were treated with bilateral vasectomy (closed epididymis) to make obstructive azoospermia(OA) rat model. Two weeks after vasectomy, bilateral standard double-armed longitudinal intussusception vasoepididymostomy(VE), single-armed and reverse single-armed longitudinal intussusception vasoepididymostomy were performed in the assigned rats. Rats in the control group underwent vasectomy only. In the sham operation group, the testes of rats were moved out of the scrotum and then returned. Rats were sacrificed after 12 weeks. The anastomosis and vasectomy sites were inspected for sperm granuloma. Patency was confirmed by injecting Methylene blue from the abdominal end of the vas through the anastomoses to epididymis. Results In the standard double-armed longitudinal intussusception vasoepididymostomy(VE), the single-armed and reverse single-armed longitudinal intussusception vasoepididymostomy groups, the patency rates were 100%, 75%, and 87.5%, sperm granuloma rates were 12.5%, 12.5%and 12.5%, the average operation times were 38.1±4.3min, 42.3±2.9 min, and 41.0±3.3 min, respectively. Conclusion Bilateral vasectomy (closed epididymis) is reliable, simple method to make obstructive azoospermia(OA) animal model, suitable for performing microscopic vasoepididymostomy(VE) training. This study suggests that the single-armed suture technique for vasoepididymostomy performing is almost as effective as the double-armed technique and can save operation cost. It allows the use of single-armed sutures to perform microsurgical vasoepididymostomy, in which double-armed sutures are not available. Reverse single-armed longitudinal intussusception vasoepididymostomy can reduce the probability of back-walling the tubular lumen.