Objectives: To analyze the factors affecting the patency rate of microsurgical single-stitch longitudinal intussusception vasoepididymostomy and to explore the possible causes of failure. Methods: The clinical data of 87 patients with epididymal obstructive azoospermia who underwent microsurgical vasoepididymostomy from January 2015 to February 2018 in the First Affiliated Hospital of Fujian Medical University were analyzed retrospectively. We observed the patency rate postoperatively and evaluated several factors that possibly related to the patency rates. Preoperative examinations included peripheral blood chromosomes, Y chromosome microdeletions, sex hormones, seminal plasma, etc. After admission, microsurgical single-stitch longitudinal intussusception vasoepididymostomy was performed. During the follow-up, the semen was evaluated to assess the patency rate and the time to patency. Results: The patient's age ranged from 21 to 42 years and the mean age was(25±3) years. Infertility lasted for 1-8 years and the mean infertility time was(2.2±1.1) years. The longitudinal intussusception vasoepididymostomy was successfully completed in 80 patients , 5 cases gave up the anastomosis surgery because of multiple segment obstruction of the vas deferens, complete obstruction of the epididymis or testicular obstruction. Two cases underwent crossed vasovasostomy( sperm was present in the ejaculate in 1 case postoperatively). Of all the patients, 72 were successfully followed up. The follow-up time was 3-29 months, with an average of (12.0±1.7)months. Excluding 3 cases of follow-up time less than 12 months who still had no sperm in the ejaculate, 69 patients' data were in cluded in the final statistics, of which 50 cases with return of sperm in the ejaculate, the overall patency rate was 72.5%(50/69), concentration of sperm was 0.1-137.2 million/ml, and the mean concentration was(29±21) million/ml; with the progressive motile sperm rate ranging from 0-57.9%, the mean rate was(29.9±21.1)%. The patency rates of motile sperm and immobile sperm found in epididymal fluid during surgery were 82.2%(37/45) and 54.2%(13/24), respectively. The patency rate of bilateral and unilateral anastomoses was 77.6%(45/58) and 45.5%(5/11), respectively; the patency rate of caput anastomosis was 47.8%(11/23), and 84.8%(39/46) for corpus or caudal anastomosis. 17 patients achieved natural pregnancy postoperatively, the rate was 34.0%(17/50). Conclusions: The therapeutic effect of microsurgical single-stitch longitudinal intussusception vasoepididymostomy is satisfactory. The motile spermatozoa in epididymal fluid, bilateral surgery and corpus or caudal anastomosis can improve the patency rate postoperatively.目的： 分析显微镜下单针缝线纵向套叠输精管－附睾吻合术的复通率影响因素并探讨复通失败的可能原因。 方法： 回顾性分析2015年1月至2018年2月间在福建医科大学附属第一医院男科行显微镜下输精管－附睾吻合术的87例附睾梗阻性无精子症患者的临床资料，观察术后复通情况等，探讨影响复通率的可能因素。术前行各项检查如外周血染色体、Y染色体微缺失、性激素、精浆生化等。入院后行显微镜下单针缝线纵向套叠式输精管－附睾吻合术，术后随访复查精液评估复通率、复通的时间等。 结果： 患者年龄21～42(25±3)岁。不育时间1～8(2.2±1.1)年。80例成功完成输精管－附睾吻合术，5例因双侧输精管多段梗阻、附睾整段梗阻或睾丸内梗阻等放弃手术，2例施行交叉输精管－输精管吻合1例术后出现精子。72例成功随访，随访时间3～29(12.0±1.7)个月。排除3例随访时间<12个月且未出现精子的患者，69例纳入最后统计，其中50例术后精液检查发现精子，总体复通率为72.5%(50/69)，精子浓度[0.1～137.2(29±21)]×10(6)/ml；精子前向运动百分率0～57.9%(29.9±21.1)%。术中附睾液中找到活动精子与不动精子的复通率为82.2%(37/45)、54.2%(13/24)；双侧与单侧吻合的复通率为77.6%(45/58)、45.5%(5/11)；附睾头部、体尾部吻合的复通率为47.8%(11/23)、84.8%(39/46)。术后17例患者配偶自然妊娠，自然妊娠率为34.0%(17/50)。 结论： 显微镜下单针缝线纵向套叠输精管－附睾吻合术的疗效满意，附睾液中找到活动精子、双侧吻合、体尾部吻合可提高复通率。.
<b><i>Objective:</i></b> The purpose of the study was to evaluate the safety and feasibility of treatment for male circumcision using modified sleeve circumcision and subcuticular suture with the Quill™ device. <b><i>Methods:</i></b> From May 2011 to March 2012, 70 consecutive cases of male circumcision were performed using an alternative technique with the Quill™ device by a single surgeon in our institution. The inclusion and exclusion criteria for the selection process of this procedure were the same as for conventional circumcision. We evaluated the indications and perioperative outcomes. The circumcisions were performed as day-case procedures under local anesthesia. <b><i>Results:</i></b> All patients were followed up for a minimum of 3-6 months. The ages ranged from 8 to 68 (mean = 27.0 years,<b> </b>SD = 10). The indications for surgery were either cosmetic (n = 16, 22.9%) or medical [redundant prepuce (n = 36, 51.4%), phimosis (n = 5, 7.1%), paraphimosis (n = 2, 2.9%), balanoposthitis (n = 9, 12.9%), melanoma (n = 1, 1.4%), and condyloma acuminata (n = 1, 1.4%)] (n = 54, 77.1%). The mean operation time in this group was 29 min (19-38 min) when the Quill™ device was used. In all, 3 cases developed complications (4.3%). The final cosmetic result was satisfactory for both the patients and their spouses or parents. <b><i>Conclusion:</i></b> This study showed that modified sleeve circumcision and subcuticular suture were safe and reliable surgical methods of circumcision that provide a better cosmetic result.
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