Vaso-epididymal anastomosis

Male family planning surgery is mainly to prevent the discharge of sperm, that is, vasectomy. In addition, it also includes the treatment of re-cultivation after infertility or sterilization, that is, vas deferens anastomosis and vas deferens epididymal anastomosis. Vas deferens surgery refers to the use of surgical or non-surgical procedures to cause spermatic tract blockade. After the testis can still continue to produce sperm, mature sperm dissolved in the epididymis, there is still a normal ejaculation process during sexual intercourse, but there is no sperm in the semen. The vas deferens sterilization is simpler, safer, and has no complications of abdominal surgery than the fallopian tube birth control. The postoperative recovery is also faster. Therefore, it is currently the main birth control measure. The vas deferens sterilization includes cutting off the vas deferens, occluding the vas deferens by means of chemical or electrocoagulation, blocking the vas deferens in the lumen, or closing the vas deferens outside the tube. Currently, the most commonly used is vasectomy, followed by vas deferens occlusion. Due to azoospermia caused by obstruction of the spermatic tract, the general obstruction usually occurs in the tail of the epididymis, and can be used for anastomosis of the vas deferens. The success rate of this procedure is far less than that of vas deferens. Curing disease: Indication The vas deferens epididymal anastomosis is suitable for: The vas deferens epididymal anastomosis is suitable for spermless sperm in the semen, obstructive lesions in the tail of the epididymis, and normal testicular biopsy. Contraindications 1. Hemorrhagic disease, mental illness, severe neurosis, sexual dysfunction, acute or severe chronic disease. 2, acute or chronic inflammation of the genitourinary system, should be cured before surgery or other birth control measures. 3, scrotal skin acute or chronic inflammation, lymphedema or other skin diseases that hinder surgery, should be cured before surgery. 4, scrotal disease, such as inguinal hernia, hydrocele, varicocele, etc., should be cured after surgery, or vaginal scrotal surgery at the same time as vasectomy. Preoperative preparation 1. Testicular biopsy and sperm angiography. If the testicular biopsy is normal and the spermatic tract is obstructed by the epididymal tail lesion, the operation can be performed. 2, combined with prostatitis, need to be treated first, and apply antibiotics before surgery. 3, acute and chronic infection of the urinary tract, scrotal skin disease and scrotal disease, to be cured and then vasectomy. 4, pay attention to the history of drug allergy, do procaine skin test. 5. Bathe before the operation, clean the vulva, and replace the cleansing pants. Shave the pubic hair before surgery. 6. Dip the penis scrotum with 1:1000 benzalkonium solution for 5 min before surgery, then dry it, then disinfect the skin with 1:1000 thiomersal or 75% ethanol; or disinfect it with 1:1000 Xinjieer solution for 3 times. Surgical procedure 1. Incision and exploration of the contents of the scrotum to make a longitudinal incision in the anterior midline of the scrotum. Cut the skin, the membrane, and the fascia until the testicular sheath wall. The blunt dissection is performed outside the parietal layer, and the testicular sheath is extruded along with the contents of the scrotum, the testicular sheath is incision, the testis and epididymis are exposed, and the epididymis vas deferens is isolated to check whether the testis, epididymis, and vas deferens have lesions. 2, seminal vesicle end vas deferens water injection test in the epididymal tail lesion obstruction above the corresponding position puncture vas deferens lumen, into the seminal vesicle end of the vas deferens injection of isotonic saline 5ml, such as water injection without resistance, the patient has a sense of urine, indicating that the seminal vesicle end of the vas deferens. 3. Cut the head of the epididymis to the upper part of the epithelial lesion, and make a longitudinal incision in the epididymis, and cut off the small tube in the epididymis. If there is liquid overflow, collect it with sterile slides, plus isotonicity. Brine, placed under a microscope to observe the presence or absence of sperm. If there is no sperm, the incision is extended in the direction of the epididymis head, and the liquid is collected for microscopic examination until sperm is found. 4. Cut the vas deferens into the vas deferens at the corresponding upper part of the epididymal lesion and make a longitudinal incision. The length is equivalent to the longitudinal incision of the head of the epididymis. The 3-0 nylon thread was inserted into the lumen from the upper end of the longitudinal incision of the vas deferens through the injection needle, and then passed through the wall of the tube and pulled out of the skin. 5, vas deferens epididymal anastomosis with 8-0 nylon line vas deferens epididymal side anastomosis. The upper and lower ends were sutured first, and the tail was pulled after ligation, and the lower end of the nylon support wire was taken out from the lower corner of the anastomosis through the anastomosis, and then the suture was made on both sides of the anastomosis of the vas deferens. Finally, the lower end of the nylon support wire is pulled out of the scrotum skin. 6, the same side of the implementation of contralateral surgery. 7. Stitching the incision to check that there is no bleeding in the incision, place the rubber drainage strip, and suture the scrotum incision with a thin silk thread. Finally, the lower two ends of the nylon support line are ligated and fixed outside the skin.