经直肠超声检查对射精管梗阻性无精症患者梗阻部位确定和选择治疗方案的应用价值

目的探讨经直肠超声检查对射精管梗阻性无精症患者梗阻部位确定和选择治疗方案的临床应用价值。方法采用高频及经直肠超声对129例梗阻性无精症患者进行检测,并依据超声判断射精管梗阻位置建议临床选择治疗方案。结果检出94例射精管梗阻性无精症,其中24例为射精管低位梗阻,选择经尿道精囊镜射精管切开术进行治疗,术后3个月检查精液均找到活精子,其中10例患者配偶受孕,活产8胎;70例为射精管高位梗阻,选择经睾丸或附睾穿刺术取精术找到活精子后行卵母细胞胞浆内单精子注射术助孕治疗,其中44例患者配偶受孕,活产39胎。结论经直肠超声检查可准确判断射精管梗阻部位,按梗阻部位不同建议采取不同的治疗方案,能有效地提高治疗成功率。     

移植肾输尿管梗阻19例临床分析

目的:探讨移植肾输尿管梗阻的原因和处理方法.方法:收集本院1994年1月～2004年4月间19例移植肾输尿管梗阻的患者,临床多表现多为尿少、尿漏和(或)血肌酐(SCr)升高,均经B超、同位素利尿性肾图或磁共振泌尿系统水成像(MRU)等影像学检查确诊,其中7例行经皮肾穿刺造瘘并顺行尿路造影明确梗阻部位.结果:19例患者经手术和组织学检查证实梗阻的原因是:输尿管或输尿管膀胱吻合口狭窄6例,输尿管过长、扭曲致梗阻3例,输尿管周感染致狭窄、穿孔2例,输尿管下段坏死、梗阻2例,输尿管外瘢痕或炎性组织压迫2例,输尿管误扎l例,输尿管内结晶并血块堵塞1例,输尿管小结石1例,膀胱肌层包埋过紧l例.19例患者中有7例行移植肾输尿管膀胱重新吻合(1例手术治疗效差,后行经皮肾穿刺造瘘),3例行膀胱瓣输尿管吻合术,2例行移植肾肾盂、输尿管粘连松解术,1例行移植肾切除术,1例输尿管误扎者术中立即予纠正.另外5例行腔内微创手术治疗(扩张通道均为14～16F),其中4例先在B超引导下行经皮肾穿刺造瘘短期引流,待SCr下降接近正常后,即行经肾造瘘输尿管镜球囊扩张狭窄段后顺行置入内支架管;1例经膀胱镜逆行插管失败后直接行经皮肾穿刺输尿管镜术.5例经皮肾穿刺输尿管镜球囊扩张、置管后,恢复顺利,未发生相关并发症.结论:移植肾输尿管梗阻病因复杂,需结合影像学检查确诊,经皮肾穿刺造瘘对本病的诊治有重要价值;积极的外科手术,特别是微创的腔内手术是改善本病预后的重要手段.     

输尿管子宫内膜异位症的手术方式探讨

目的探讨治疗输尿管子宫内膜异位症的手术方式。方法回顾分析2002～2011年病理证实的23例输尿管子宫内膜异位症患者的临床诊治资料。结果 23例患者中,3行输尿管粘连松解术,6例行输尿管狭窄段切除+输尿管膀胱再吻合术,12例行输尿管狭窄段切除+输尿管端端吻合术,2例行输尿管镜下病损电切术。术后病理诊断均为子宫内膜异位症。8例接受了术后激素辅助治疗。术后随访成功的20例患者均未出现复发。结论输尿管子宫内膜异位症是一种临床少见的疾病。对于伴有肾积水的患者,治疗上以手术治疗为主,内分泌治疗为辅。对于轻度的输尿管梗阻患者,推荐行输尿管粘连松解术治疗;对于中重度输尿管梗阻患者,推荐行输尿管狭窄段切除的手术治疗。     

经尿道等离子电切术联合输尿管镜下D—J管逆行置入治疗输尿管口周围膀胱肿瘤

目的观察经尿道等离子电切术联合输尿管镜下D—J管逆行置入治疗输尿管口周围膀胱肿瘤的疗效。方法16例输尿管口周围膀胱肿瘤患者均行经尿道等离子电切术联合输尿管镜下D—J管逆行置入治疗。结果16例均顺利完成手术,平均手术时间为63min。术中出血56ml,无输血者。无围手术期并发症。术后病理诊断：膀胱尿路上皮癌。术后随访10-58个月,平均28．9个月,复发3例,均行经尿道膀胱肿瘤切除术,术后再未复发,随访期间无死亡病例。术后6个月有2例输尿管轻度反流,术后1a有1例输尿管轻度反流。元输尿管口狭窄发生,同侧肾功能无影响。结论经尿道等离子电切术联合输尿管镜下D-J管逆行置入治疗输尿管口周围膀胱肿瘤有效、安全。     

经皮肾镜与经尿道输尿管镜取石术对老年输尿管上段嵌顿性结石患者的疗效及对肾功能的影响

目的探讨经皮肾镜与经尿道输尿管镜取石术对老年输尿管上段嵌顿性结石患者的疗效及对肾功能的影响。方法 61例老年输尿管上段嵌顿性结石患者随机分为经皮肾镜取石术组31例及经尿道输尿管镜取石术组30例。比较两组患者结石清除率、手术时间、术后行体外冲击波碎石术(ESWL)的辅助率,以及两组术式对肾功能的影响。结果经皮肾镜取石术组结石清除率明显高于经尿道输尿管镜取石术组,手术时间明显低于经尿道输尿管镜取石术组,术后经皮肾镜取石术组需行ESWL的辅助率明显低于经尿道输尿管镜取石术组(P0.05);两组血尿素氮(BUN)、血肌酐(SCr)水平无统计学差异,两组患者血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)均明显升高,经尿道输尿管镜取石术组NGAL升高更明显(P0.05)。结论经皮肾镜取石术疗效显著,且对肾功能影响小。     

经皮肾造瘘联合经尿道输尿管镜治疗第4腰椎水平输尿管结石

目的探讨经皮肾穿刺造瘘联合经尿道输尿管镜在治疗第4腰椎水平输尿管结石的应用及疗效。方法回顾性分析2008年9月~2009年9月经皮肾穿刺造瘘联合经尿道输尿管镜气压弹道/钬激光碎石治疗20例第4腰椎水平输尿管结石患者临床资料。结果 20例均在B超引导下成功穿刺建立经皮肾通道,留置肾造瘘管于肾盂输尿管连接部,一期行经尿道输尿管镜碎石,手术时间平均48（30~70）min,清石率100%,未出现严重并发症。结论经皮肾穿刺造瘘联合经尿道输尿管镜治疗第4腰椎水平输尿管结石安全、有效。     

内镜治疗急性梗阻化脓性胆管炎32例

[目的]探讨内镜治疗急性梗阻化脓性胆管炎的临床应用价值。[方法]32例急性梗阻化脓性胆管炎患者在内镜下行胆管造影,据病情分别行经鼻胆管引流（ENBD）术和十二指肠乳头切开（EST）术及取石后ENBD术。[结果]插管成功率96．9％,插管后引流成功率100％。[结论]内镜治疗急性梗阻化脓性胆管炎是安全有效的治疗方法。     

173例胰胆管疾病患者内镜逆行胰胆管造影术诊治分析

目的 讨论内镜逆行胰胆管造影术(ERCP)及内镜治疗对胰胆管疾病的诊断与治疗价值。方法 回顾分析173例胆胰疾病患者应用十二指肠镜进行诊断和治疗的临床效果。结果 ERCP成功率为93．6％，造影发现胆道结石69例，一次性成功取净结石66例，造影发现胆胰肿瘤20例，5例放置内支架引流。ERCP术后胰腺炎2例，十二指肠乳头肌切开(EST)术后出血2例，均经非手术治疗痊愈。结论 ERCP对于胆胰疾病的诊断明确可靠，内镜下治疗可使部分患者免除外科手术。     

经输尿管镜钬激光内切开术治疗尿道狭窄或闭锁34例

目 观察经输尿管镜钬激光内切开术治疗尿道狭窄或闭锁的疗效及安全性。方法对34例尿道狭窄或闭锁患者于输尿管镜直视下以钬激光放射状内切开狭窄处瘢痕,修平尿道创面,术后留置导尿管1—2周。观察术后排尿通畅情况及最大尿流率（MFR）变化。结果34例手术过程均顺利,29例一次手术治愈,4例经多次尿道扩张后治愈,1例术后3个月尿线变细者行二次钬激光内切开术后好转;术后均无尿失禁及明显出血;术后2周、3个月及1aMFR分别为（21．3±4．1）、（19．5±2．8）、（16．2±3．5）ml／s,均显著高于术前（P〈0．01）。结论经输尿管镜钬激光内切开术治疗尿道狭窄或闭锁疗效确切、安全微创;可同时处理并发的膀胱或输尿管结石。     

床旁纤维支气管镜在治疗慢性阻塞性肺疾病合并呼吸衰竭中的应用价值研究

目的观察采用床旁纤维支气管引导下经鼻气管插管及支气管肺泡灌洗在治疗慢性阻塞性肺疾病合并呼吸衰竭患者中的临床应用价值。方法 36例慢性阻塞性肺疾病合并呼吸衰竭患者采用床旁纤维支气管镜引导下经鼻气管插管、支气管肺泡灌洗等气道管理治疗,观察其疗效。结果 36例慢性阻塞性肺疾病合并呼吸衰竭患者均为1次性插管成功,插管时间2min,及时的支气管肺泡灌洗可以清除气道分泌物、获得病原学诊断,无严重并发症发生。结论床旁纤支镜引导下经鼻气管插管并支气管肺泡灌洗在治疗慢性阻塞性肺疾病合并呼吸衰竭的患者中具有重要的应用价值,值得推广应用。     

Evidence for reversible and irreversible biochemical defects in accessory sex organs and kidney of neonatally androgenized male mice

Studies were conducted to evaluate the effects of neonatal administration of supraphysiological doses of testosterone on the growth, hormone responsiveness, dna and protein content, and protein profiles of the epididymis, vas deferens and seminal vesicles in adult mice. Results indicate that in androgenized males, testicular growth (DNA and protein content), circulating and organ androgen levels, and fertility were significantly depressed. The weights of the epididymis, vas deferens, seminal vesicle and kidney, but not that of the spleen, were significantly diminished subsequently to a reduction of protein (all organs) and DNA (epididymis, vas deferens) content. The efficacy of testosterone in promoting accessory sex organs and kidney growth, in adult castrated males, was persistently reduced in neonatally androgenized males. When assessed by DNA content, the response of all organs (except the seminal vesicle) was similar to that of controls, but it was significantly reduced from 16 to 43% when measured in terms of protein content. The protein profiles from seminal vesicles and vas deferens analysed by polyacrylamide gel electrophoresis, showed reproducible persistent alterations which could be reversed by adult androgen therapy.     

Effect of sexual maturation and androgens on prostaglandin levels in tissues of the male reproductive system in mice.

Prostaglandins E and F were measured in the testis, epididymis, vas deferens, and seminal vesicles of CD-1 mice from 2 to 8 weeks of age. The concentration of PGF was higher than that of PGE in all organs studied, except for the vas deferens. The concentration of prostaglandins (PGs) was age-dependent, showing a progressive decline from immaturity to adulthood. However, in the testis, there was an apparent transient increase in the concentration of PGs in the seminal vesicle changed very little between the ages of 5 and 8 weeks. The vas deferens had a significantly higher PG concentration than any of the organs studied, and a unique pattern of changes in the levels of PGE and PGF with age. In the vas deferens of two- and three-week-old mice, the concentration of PGF was higher than the concentration of PGE, but after 4 weeks of age PGE became somewhat more abundant than PGF. Treatment of immature mice with testosterone propionate (TP) produced significant changes in PG concentrations, resulting in PG levels resembling those of adult animals. The treatment also changed the ratio of PGE to PGF in the vas deferens (from 1:2 to 1:1). Hereditary dwarf mice had higher levels of PGs in the tissues of the male reproductive system than did their normal littermates. The treatment of dwarf mice with TP generally reduced the concentration of PGs in their reproductive system and resulted in a PG pattern more characteristic of normal adult males of the same strain. The data demonstrate pronounced changes in PG levels in the tissues of the male reporductive system of mice during sexual maturation. From the present study and from previous findings, it can be concluded that these changes can be accounted for by an increase in testicular testosterone secretion.     

无精子症患者血清生殖激素、精浆生化指标变化及意义

目的探讨无精子症患者血清生殖激素和精浆生化指标变化及意义。方法采用化学发光免疫分析法,对35例无精症患者和35例男性有正常生育史者进行血清促卵泡成熟激素（FSH）、黄体生成素（LH）、睾酮（T）检测,并对其精浆酸性磷酸酶、α-糖苷酶、果糖进行检测。结果与正常者比较,无精子症患者血清FSH、LH明显升高,T、T／LH比值明显降低;精浆α-糖苷酶活性和果糖明显降低（P均〈0．05）。结论FSH水平是预测睾丸生精功能的可靠标志,T／LH比值可作为早期判断睾丸间质细胞功能状态的敏感指标;血清生殖激素及精浆生化检测是鉴别梗阻性与非梗阻性无精症的指标,对判定睾丸功能损害程度和输精管梗阻有重要意义。     

Immotile-cilia syndrome with azoospermia: a case report and review of the literature

A case of immotile-cilia syndrome associated with azoospermia is presented. This diagnosis is based on a typical history of bronchitis, sinusitis, situs inversus, impaired nasal mucociliary clearance and characteristic ultrastructural defect in the respiratory tract cilia and in the sperm tail. Semen analysis showed azoospermia with no evidence of obstruction in the epididymis or vas deferens; there was normal spermatogenesis.     

Immunohistochemical localization of microsomal PGE synthase-1 and cyclooxygenases in male mouse reproductive organs

We investigated the tissue distribution and cellular localization of microsomal PGE synthase-1 (mPGES-1) and cyclooxygenase (COX)-1 and -2 in the male mouse reproductive organs. Northern blotting revealed that the mPGES-1 mRNA was expressed intensely in the epididymis and weakly in the lung, spleen, skin, kidney, colon, and brain. In the male reproductive tract, the expression of mPGES-1 increased from the testis to the cauda epididymis and was highest in the vas deferens when examined by Northern blotting, RT-PCR, and Western blotting. By immunohistochemistry, mPGES-1 was detected in Leydig cells of the testis and in epithelial cells of the epididymis, vas deferens, and seminal vesicles. In addition, the caput and cauda regions of the epididymis and the vas deferens in this order showed a progressive increase in the expression of COX-1 mRNA and immunoreactivity, whereas COX-2 was dominantly expressed in the vas deferens. COX-1 was localized in epithelial cells of the caput, corpus and cauda epididymis and of the vas deferens, and COX-2 was evident in epithelial cells of the distal cauda epididymis and vas deferens. These results show that mPGES-1 is expressed coordinately with COX-1 and COX-2 and is involved in PGE(2) production in male genital organs.     

The effect of efferent duct ligation on the uptake of 65-ZN by the epididymis and vas deferens of rhesus monkeys (Macaca mulatta)

A study dealing with the uptake of zinc-65 by different segments of the epididymis and vas deferens of the rhesus monkey (Macaca mulatta) in the presence or absence of spermatozoa is reported. It was determined that zinc-65 uptake by the vas deferens of the control side was significantly higher than that of the epididymal segments (vas deferens vs. caput, proximal and distal corpus, or cauda, p less than .01). Amon g the epididymal segments themselves there was no significant difference . Efferent duct ligation consistently reduced the uptake of zinc-65 in all portions of the epididymis and vas deferens (control vs. ligated: caput, corpus, cauda, and vas, p less than .01). The percentage reduction in the uptake by different segments of the epididymis and vas remained virtually constant in the ligated side (caput, 57%; proximal corpus, 53%; distal corpus, 64%; cauda, 55%; vas deferens, 55%). Nevertheless, zinc-65 uptake by vas continued to be significantly greater than that of the epididymis. It is noted that the reduced zinc-65 accumulated on the ligated side could at least be partly due to absence of spermatozoa. It is further suggested that the lowered uptake of zinc-65 by the epididymis and vas deferens following efferent duct ligation in the monkey may be also due to a local androgen deficiency.     

Hypertrophic subaortic stenosis: Clinical and hemodynamic effects of long-term propranolol therapy

Thirteen patients with hypertrophic subaortic stenosis underwent right and transatrial septal left heart catheterization. Outflow obstruction was measured in the resting state and during a variety of stimulating maneuvers before and after the intravenous administration of 150 μg/kg of propranolol. The patients were then treated with orally administered propranolol and followed up for an average period of 17 months. Nine patients were available for a second catheterization, during which detailed hemodynamic measurements were repeated. Most patients had an initially favorable response to propranolol. However, 3 with an initially good response had a return of symptoms during the period of study. The initial clinical response appeared to correlate with the reduction of outflow obstruction seen after intravenous administration of propranolol. The long-term clinical course correlated with the hemodynamic findings at the second catheterization. The severity or lability of the outflow obstruction during the initial catheterization did not appear to have predictive value for the patient's response to long-term therapy. Propranolol had a favorable effect on the symptomatic state of the patients, but did not appear to change the course of the underlying disease.     

Seminal vesicle calculus after transurethral resection of ejaculatory duct

We report a case of symptomatic seminal vesicle calculus following transurethral resection of ejaculatory duct. A 37-year-old male, who had previously undergone transurethral resection of ejaculatory duct, presented with perineal discomfort and graveluria. Computed tomography revealed a calculus situated within a dilated left seminal vesicle. The patient was treated with cystoscopy and litholapaxy of the seminal vesicle calculus. Although rare, our case demonstrates that seminal vesicle calculi formation can occur following treatment of ejaculatory duct obstruction, possibly secondary to urinary reflux and stasis.