经直肠超声在梗阻性无精子症检查中的应用价值

目的探讨经直肠超声在梗阻性无精子症检查中的临床价值。方法回顾性分析42例临床诊断为梗阻性无精子症患者的临床资料,总结分析梗阻性无精子症患者的前列腺、精囊及射精管的经直肠声像图表现。结果本组病例前列腺的体积为8.2~19.9 mL,平均13.5 mL,经直肠超声检查前列腺、双侧精囊腺、输精管壶腹及双侧射精管无异常者23例,前列腺发育不良2例,前列腺中线部位囊肿4例;双侧精囊发育不良或缺如4例,精囊慢性炎症2例;射精管囊肿3例,射精管结石2例,射精管闭锁1例,射精管慢性炎症1例。结论梗阻性无精子症的梗阻原因多样;经直肠超声可以清晰显示前列腺、精囊及射精管的结构与病变,有助于判断梗阻性无精子症的病变类型及梗阻部位,可视为梗阻性无精子症的首选检查方法。     

500例无精子症诊治的回顾性分析

目的:回顾分析500例无精子症的临床诊治,为提高男性不育症规范化诊治水平提供参考。方法:回顾性分析2012年12月—2013年12月间收治的无精子症患者500例,根据中华医学会2013版《男科疾病诊治指南系列男性不育症诊疗指南》诊断为梗阻性、非梗阻性、混合性无精子症;分别提供附睾、输精管、射精管等精道重建手术、药物治疗、体外受精(IVF)/胞浆内单精子注射(ICSI)、供精人工授精(AID)及收养等方案供患者夫妇知情选择。结果:500例中梗阻性无精子症254例、非梗阻性无精子症187例、混合性无精子症40例,Y染色体AZFa或AZFb微缺失所致的无精子症19例。手术治疗的44例患者中,14例接受精囊镜射精管囊肿切开术、5例接受输精管-输精管吻合术、25例接受输精管-附睾吻合术;其中33例在术后3~12个月内行精液检查发现精子,2例在术后3~8个月女方自然妊娠;药物治疗的19例患者中,7例炎症性梗阻患者给予抗生素治疗1~3个月后,3例在3~6个月精液检查时发现精子,其中1例在治疗后5个月内女方自然妊娠,其余4例患者的生殖系统不适症状较前明显缓解;12例低促性腺激素患者给予卵泡刺激素(FSH)和(或)人绒毛膜促性腺激素(h CG)治疗,其中包括1例Kallmann综合征,9例患者经3~12个月随访,睾丸体积明显增大(4~8 m L),血清睾酮明显增高,其中5例在6~12个月内精液中出现精子;IVF/ICSI治疗组的376例患者12个月内成功妊娠者196例;其余61例选择AID或收养。结论:依据中华医学会《男科疾病诊治指南系列男性不育症诊疗指南》谨慎有创操作,倡导医患共同决策诊疗行为,对于临床上无精子症规范化与合理的诊治具有积极意义。     

先天性输精管缺如性无精子症患者诊治分析

目的 分析与诊断先天性输精管缺如性无精子症,经附睾穿刺取精后行ICSI助育,探讨其助育结果.方法 结合查体,精液检查,超声检查,内分泌检查,精浆生化,必要时输精管造影.确诊为先天性双侧输精管缺如患者57例行附睾穿刺,倒置显微镜下观察发现有活动精子者行ICSI助育.结果 在双方完善相关检查后行ICSI助育,57例患者有30例于新鲜周期妻子妊娠(妊娠率52.63%),15例冷冻周期妻子妊娠,9例冷冻周期失败,行第2周期治疗,6例妊娠,3例失败,3例无冷冻胚胎,拟第3次治疗.结论 先天性双侧输精管缺如是由于CFTR基因突变所致的发育畸形,正确的临床诊断和采取合理的辅助生殖技术是目前该类患者治疗的较好方案.     

腹股沟疝修补术致双侧输精管梗阻的临床研究

目的:探查腹股沟疝修补术导致输精管梗阻的原因及输精管再通的可复性。方法:做患者双侧输精管造影确定梗阻部位,并对患侧行手术探查及通液。结果:输精管造影显示双侧输精管显影至耻骨联合上方两侧,探查术中可见右侧腹股沟管中段近睾端输精管断端,输精管远端消失;对左侧腹股沟管内环口处输精管局部狭窄的可疑梗阻部位进行穿刺,用6号平针头加压突破输精管狭窄梗阻部位,有明显突破感。然后行输精管注水通畅试验,再向睾丸方向输精管穿刺抽取精液化验可见成活精子。结论:输精管断离和手术钳夹输精管损伤,是腹股沟疝修补术导致输精管梗阻的两种原因,再通治疗困难。而采用针头穿刺疏通法时未放置导丝,易引发术后输精管管腔粘连导致再次梗阻。     

男性生殖道梗阻性疾病的病理生理学研究进展

男性生殖道也称男性泌尿生殖道,包括生精管道(睾丸)、输精管道(附睾、输精管、射精管、尿道)及其附属腺体(精囊腺、前列腺、尿道球腺等).男性生殖道梗阻性疾病主要见于输精管道梗阻.输精管道不仅是精子的通道,而且具有促进精子成熟和获得活动力的功能.输精管道梗阻不仅使精子无法正常排出而引起不育,而且引起患者局部和/或全身的内分泌和免疫学变化.现将男性生殖道梗阻性疾病的病理生理学变化综述如下.     

附睾精池精道再通术治疗附睾阻塞性无精症

精道阻塞性无精子症占男性不育的 10 %～14 % ,其中附睾尾部阻塞最为常见。对于附睾尾部精道阻塞性无精子症 ,传统的手术治疗效果不好 ,近年来少有报道。我院在传统输精管附睾吻合术的基础上 ,采用附睾精池成型精道再通的方法治疗附睾阻塞性无精症 12例 ,疗效满意 ,报告如下。1　资料与方法1.1　病例的选择　我院自 1997- 2 0 0 2年共收治附睾阻塞性无精子症患者 12例 ,年龄 2 3～ 4 0岁 ,平均31岁 ,均为夫妇同居 1～ 4年不育 ,未避孕 ;均有 2～6年泌尿生殖道感染史 ;第二性征及外生殖器正常 ,睾丸输精管无异常 ,附睾触诊均有程度不同的肿大…     

显微镜下纵向套入式输精管附睾管吻合术治疗梗阻性无精子症

目的 探讨显微镜下纵向套入式输精管附睾管吻合术治疗梗阻性无精子症的疗效.方法 利用手术显微镜对27例梗阻性无精子症患者行纵向两针套入式输精管附睾管吻合术,术后3个月起,开始复查精液常规,两次间隔1个月左右,并随访配偶受孕率.结果 术中发现13例(22侧)梗阻部位在附睾尾部或近睾段输精管,11例(19侧)梗阻部位在附睾体部,13例单侧附睾头部梗阻.双侧吻合12例,单侧吻合15例,所有吻合侧输精管近端均通畅.23例患者随访6个月以上,13例患者随访12个月以上;17例(62.96%)术后3～6个月从精液中检出精子,其中4例(14.81%)配偶受孕成功.精子数为(1.5～65.5)×106/L,精子活率为0～66.0%,精子活动力为3.7%～69.0%.结论 显微镜下纵向两针套入式输精管附睾管吻合术,术式简单,是治疗梗阻性无精子症的有效方法.     

精液沉渣分析:一种可探测常规精液检查无精子症患者精液中精子的方法

自微穿刺技术亦即胞浆内精子注射应用以来,以前曾被认为不能生育者,现在只要有成熟精子存在,即可获得生理性妊娠的可能。研究精液离心后发现精子的频率,该技术称为精液沉渣分析,可对常规精液检查被确认为无精子症患者的精液进行分析。 1995～1996年间,对140例常规精液检查证实无精子症者,分别留取精液进行离心,取精液沉渣进行检查。对梗阻性无精子症患者进行分类,包括行输精管复通失败者,先天性或后天性输精管梗阻重建失败者,经阴囊     

梗阻性无精子症

精子是男性的“生育使者”,精液中无精子,即不可能有生育能力,是不育病人中较难解决的病症之一。造成无精子症的原因较多,但约有一半人是属于梗阻性无精子症。 人的睾丸由200多个睾丸小叶组成,每一个小叶内含有3～4个曲细精管,是产生精子的“摇篮”。精子产生后,依次通过附睾、输精管、射精管(由精囊腺排泄管与输精管末端汇合而成)、尿道等生殖管道排出。如果这些生殖管道由于疾病发生“交通堵塞”,精子就排不出来,称为梗阻性无精子症。     

附睾精子吸引术体外受精的尝试

对5例输精管阻塞及重度生育力低下不育患者的附睾精子吸引术体外受精结果进行报告。 5例患者中,腹股沟疝术后输精管阻塞1例;不明原因无精子症2例;睾丸活检有少量分化正常的精子,输精管造影正常,输精管感染精子无力症1例,脊髓损伤不射精1例。腰椎麻醉,切开阴囊,显露睾丸附皋,在手术显微镜下切开附睾尾部被膜约5×5mm~2,除去被膜下脂肪组织,显露附睾管。用30gauge针头刺入附睾管吸取管内液,立即镜检。如无活动精子,沿切开部位向附睾头部移动,直至查到活动精子为止。精子取出后,经4～6小时培养,供体外受精。结果:取精成功3例,活动精子总数为116～345×10~4,卵子受精率52%。虽均未达到妊娠,但     

Influence of high-dosage perinatal androgen on the sexual behavior,gonadotropin secretion,and sexual organs of the rat

Combined pre- and postnatal high-dosage androgen administration to female rats resulted in internal, external, and behavioral pseudohermaphroditism. These gonadal female animals were able to develop an epididymis, ductus deferens, seminal vesicle, prostrate, and penis. The vaginas of these animals were completely aplastic, without regression of the uterogenic part of the Müllerian duct. The sexual behavior of these animals was totally inverted: they did not display female behavior, but after androgen substitution during adulthood were strongly male, including having the ejaculatory response. Female rats which had received a one-time injection of 1.25 mg TP on postnatal day 3 displayed, after postpubertal androgen treatment, fully developed male behavior. Female-type conduct was not fully suppressed. Female rats which had received a single injection of 0.02 mg TP on postnatal day 3 and postpubertal androgenization displayed masculinized sexual behavior and kept this behavior under succeeding endogenous estrogen influence.Translated and condensed fromZentralblatt für Gynakologie 6:(23) (1971).     

MRI对血精性精囊炎的诊断价值

目的分析血精性精囊炎的MRI表现，探讨MRI在血精性精囊炎诊断中的价值。方法回顾性分析了25例血精性精囊炎的MRI表现，观察其形态、大小及内部异常信号改变，分别采用SE T1WI(TR/TE558／14ms)，Flash 2D水激励T1WI(TR/TE18．5／5．2ms)，TSE T2WI(TR/TE 4000／99ms)加脂肪抑制序列扫描。结果本组25例血精性精囊炎均表现为两侧精囊体积增大；精囊内“出血”于SE T1WI呈斑片状／斑点状高信号，此高信号影于Flash 2D水激励T1WI序列显示更清晰，低信号精囊管道壁因高信号出血衬托而得以显示；精囊内“出血”于TSE T2WI呈相对较低信号，低信号精囊管道壁被较低信号出血影掩盖而显示不清。结论MRI能对血精性精囊炎做出明确诊断，是血精性精囊炎最可靠的影像学检查方法。     

Seminal Plasma Levels of PAPP-A in Normospermic and Oligospermic Men and Tissue Localization of PAPP-A in the Male Genital Tract

Radioimmunoassay, gel filtration, isoelectric focusing, and immunoperoxidase methods were used to study the levels, properties, and localization of pregnancy-associated plasma protein A (PAPP-A) in the human seminal plasma and male genital tract. Seminal plasma specimens from 20 normospermic and 20 oligospermic men were studied. PAPP-A was found in 30 of 40 samples, the levels ranging from undetectable to 135 μg/liter (median 35 μg/liter) in the normospermic group and from undetectable to 111 μg/liter (median 21 μg/liter) in the oligospermic group. There was no significant difference in the PAPP-A levels between the two groups, and no correlation was observed between the seminal plasma PAPP-A levels and the volume of seminal plasma or the sperm count or the viability of spermatozoa. Serial dilutions of seminal plasma and PAPP-A standard yielded parallel dose-response curves, and incubation with seminal plasma did not result in any change in the elution pattern of [¹²⁵I] PAPP-A in gel filtration. PAPP-A-immunoreactive material from seminal plasma eluted as two peaks, the major one corresponding to the elution volume of purified PAPP-A and the minor eluting more slowly. The isoelectric point of seminal plasma PAPP-A was 4.3-4.7 and that of term pregnancy serum was 4.2-4.6. In the immunoperoxidase staining, PAPP-A was seen in the epithelium of the prostate, seminal vesicle, and the ampullar part of the vas deferens but not in the testis, epididymis, proximal parts of vas deferens or urethra. The results confirm the occurrence of PAPP-A in the seminal plasma but do not suggest any clinical utility for seminal plasma PAPP-A measurements. Distal glandular parts of the genital tract are the site of PAPP-A localization in tissue, indicating either synthesis or uptake.     

Preclinical evaluation for noninvasive reversal following long-term vas occlusion with styrene maleic anhydride in langur monkeys

A preclinical evaluation for reversal through a noninvasive approach following long-term vas occlusion with styrene maleic anhydride (SMA) has been attempted in langur monkeys at the level of semen parameters, sperm functional tests, semen biochemistry, histology and ultrastructure of reproductive organs, hematology and serum clinical biochemistry including antisperm antibodies (ASA), prostate-specific antigen (PSA) and testosterone. Noninvasive reversal through palpation, percutaneous squeezing and electrical stimulation, forced vibratory movements and suprapubic percussion in the inguinal segments and per-rectal digital massage was attempted in seven langur monkeys after 540 days following vas occlusion. The results revealed instant azoospermia reversal on the same day of reversal with impaired sperm quality, which showed gradual improvement and normospermia with normal motility and viability after 60-90 days of reversal. Sperm functional tests, including ultrastructure of spermatozoa, indicative of sterility in the initial ejaculations, reached normalcy after 90-120 days of reversal. The seminal plasma biochemistry indicative of obstructive azoospermia regained a normal pattern after 90-120 days of reversal. The morphology of testes that showed focal degeneration during 540 days of vas occlusion and that of vasa deferentia that showed exfoliation of epithelial cells resumed to normal morphology comparable with control animals after 150 days of reversal. The morphology of the epididymis, seminal vesicle and prostate did not show appreciable changes following vas occlusion and after noninvasive reversal compared with those of control animals. Hematology, serum clinical chemistry, ASA, PSA and testosterone fluctuated within control limits, indicating safety of the procedure at the level of accessory reproductive organs. The results suggest that noninvasive reversal is feasible even after long-term vas occlusion with SMA and is safe without adverse side effects.     

Clinical and Radiological Evaluation of Ejaculatory Duct Obstruction

Ejaculatory duct obstruction (EDO) is a rare but surgically correctable cause of male infertility. With the advent and increased use of transrectal ultrasonography and magnetic resonance imaging, abnormalities of the ejaculatory duct (ED) related to infertility have been diagnosed more frequently. Recently, with the increased awareness of functional obstruction of ED, reports have been focusing on the diagnosis of partial or functional EDO. We present 2 review of the ED pathologies, imaging modalities and treatment options.     

腹腔镜诊治女性继发性不孕136例分析

目的:探讨腹腔镜对女性继发性不孕的诊断和治疗价值。方法:对136例继发性不孕妇女进行腹腔镜检查,对发现的盆腔疾病进行相应的治疗统计。结果:腹腔镜检查引发继发性不孕的盆腔器质性病变136例,检查阳性率为100.0%。其中盆腔粘连72例,占52.9%;子宫内膜异位症55例,占40.4%。盆腔粘连和子宫内膜异位症患者中分别有90.9%(72/136)和7.6%(55/136)合并有一侧或双侧输卵管梗阻。盆腔粘连患者多无急性盆腔炎病史,有61.1%(44/72)的患者没有自觉症状。其他原因引起的继发性不孕导致合并有一侧或双侧输卵管梗阻9例。结论:盆腔粘连、输卵管梗阻和子宫内膜异位症是女性继发性不孕的主要病因。腹腔镜对诊断女性继发性不孕的盆腔病因以及针对性治疗有着重要的临床价值,值得广泛推广。     

原发性精囊癌的诊断和治疗(附4例报告)

目的 探讨原发性精囊癌的临床表现、诊断及治疗.方法 回顾性分析4例原发性精囊癌患者的临床症状、体征、检查结果、手术方案及术后治疗.1例行双侧精囊连同膀胱、前列腺、直肠根治性切除术.2例行精囊、部分膀胱、前列腺切除术.1例行精囊、膀胱、前列腺、输尿管下段、直肠前壁切除术及回肠膀胱术.结果 2例患者术后随访5年未见复发与转移,1例术后2年死于结肠癌,1例术后随访3个月未见复发与转移.结论 原发性精囊癌的临床表现为血精或血尿,下尿路梗阻症状,大便性状与次数的改变,早期症状不明显,患者血清中前列腺特异抗原(PSA)、CEA阴性,细胞角蛋白(CK)阳性.治疗主要根据肿瘤侵及的范围采取相应的手术方式予以切除,术后应加以联合化疗.     

A short-term evaluation of semen and accessory sex gland function in phase III trial subjects receiving intravasal contraceptive RISUG

Following the intravasal injection of a new male contraceptive RISUG (reversible inhibition of sperm under guidance) in volunteers, routine semen analysis, semen biochemistry and germ cell morphology were evaluated in comparison with the corresponding preinjection samples for a maximum period of 6 months. Sperm counts in all 25 subjects before injection varied from 45 to 120 x 10(6)/ml. Out of 25 subjects, 6 became azoospermic after 1 month, 15 after 2 months, 3 after 3 months and 1 after 4 months of contraceptive injection. The mean volume of the ejaculates was found to be less as compared to preinjection samples. Occasional sperm or sperm heads and immature germ cells were identified in only a few postinjected subjects. However, no pregnancy was reported in these subjects during the study period. Abnormal morphology found in most of the sperm, but not in the accompanying immature germ cells, may be due to a charge-related effect on the former but not on the latter cells. Neutral alpha-glucosidase, the biochemical marker for epididymis, was estimated to be significantly lower in the seminal plasma of all the postinjected subjects. On the other hand, acid phosphatase activity and fructose levels in the seminal plasma were found to be in the normal range. Based on the above findings, it is concluded that at least for the present study period, RISUG, a new male contraceptive, is effective as a partially occluding agent in the vas deferens.     

胆囊切除术致胆管损伤的临床分析——附15例报告

目的 探讨开腹及腹腔镜胆囊切除术致胆管损伤的原因及防治措施。方法 回顾性分析胆囊切除术致胆管损伤15例的临床资料。其中，开腹胆囊切除术11例，腹腔镜胆囊切除术4例。结果 开腹胆囊切除术中胆总管横断1例，行对端吻合；胆管壁损伤6例，修补放T管引流；其余4例再次手术行胆肠吻合术。腹腔镜胆囊切除术中胆总管横断1例、肝总管电灼伤2例，行二期胆肠吻合术；胆总管被钛夹夹闭1例，行钛夹松开，胆囊管残端重新缝扎，所有病例均治愈。结论 胆管损伤在术中早期发现并且妥善处理．可避免术后胆管狭窄的发生，术后发现者胆肠吻合疗效肯定。     

乙醇对实验大鼠精浆生化指标的相关性影响研究

目的：建立慢性饮酒实验大鼠模型,测定精浆生化（α-葡萄糖苷酶、酸性磷酸酶、精浆果糖、精浆锌）的含量变化,探讨不同酒精含量对大鼠精浆生化的影响。方法：将40只健康雄性成年SD大鼠随机分为四组,其中对照组给予蒸馏水灌胃,酒精组分别给予无水酒精0.5 g/（kg·d）、2.5 g/（kg·d）、5 g/（kg·d）灌胃,连续20周。测定各组实验大鼠精浆生化（α-葡萄糖苷酶、酸性磷酸酶、精浆果糖、精浆锌）的含量变化。结果：各酒精组实验大鼠精浆生化指标均明显低于正常对照组,差异均有统计学意义（P〈0.01）;而中、高剂量组实验大鼠精浆生化指标均明显低于低剂量组,差异均有统计学意义（P〈0.05或P〈0.01）。结论：酒精可影响雄性实验大鼠附属性腺的功能,导致雄性实验大鼠生殖系统损害,其中,中、高剂量乙醇的影响大于低剂量乙醇。