输精管结扎术残端处理方式与再通关系的研究

用７种残端处理技术完成的２３７３例输精管结扎术的一项前瞻性研究表明，术后２年随访时共有７８例查见精子，其中２７例配偶受孕，精子阳性率为３．２９％，再孕率１．１４％。各种术式的精子阳性率：附睾端开放加包埋０．５５％，两端单纯结扎１．４１％，结扎加筋膜包埋２．６３％，石碳酸烧灼３．１７％，精囊端折叠３．７１％，结扎加电灼４．７５％和不作包埋的附睾端开放７．５３％。经统计学处理各种术式的精子阳性率之间差异有非常显著意义（Ｐ＜０．０００１）。由不同手术者完成的相同术式结果分析表明，除石碳酸烧灼组以外，其余各组皆无组内差异。７个残端处理组的并发症发生率有显著差异（Ｇ＝２０．９６，Ｐ＜０．０１）、其中不作包埋的附睾端开放组并发症发生率达２．１７％，折叠组的出血和感染等发生虽少，但术后近期局部结节反应发生率达４．７７％。本研究表明，输精管残端处理方式的不同可能影响术后节育效果和安全性，但手术者经验和技术水平也起很大作用。     

胸腺切除治疗重症肌无力34例体会

自１９８０年４月至１９９５年９月，采用胸腺切除治疗重症肌无力３４例，年龄５～６２岁，术后早期死亡１例，死亡率２．９４％，３３例随访３个月至１２年，１年内缓解和改善率为８７．９％（２９／３３），１～３年缓解和改善率为８８．５％（２３／２６），３年以上缓解和改善率为８０．０％（４／５）。随访结果表明胸腺切除治疗重症无 力效果满意，延迟拔除气管插管或早期行气管切开术，是防治术后重症肌无力危象的有效措施。     

小切口阑尾切除263例应用体会

９９２年５月至１９９７年５月，我院共行阑尾切除术４２３例，其中以３ｃｍ小切口切除阑尾２６３例，占６２．２％。２６３例中，病程６小时至４天不等，１天以内者１７１例（６５．０％）；伴发热９４例（３５．７％），均低于３８．５℃；ＷＢＣ均升高，在１０．０×１...     

重症心脏瓣膜病的外科治疗

自１９８５年６月～１９９５年１月共收治重症心脏瓣膜病３０８例。重症病例判断标准为：（１）心功能Ⅳ级；（２）急诊手术；（３）心胸比率≥０．８０；（４）合并冠心病需行搭桥术；（５）ＬＶＥＤＤ≥８０ｍｍ或ＬＶＥＳＤ≥６０ｍｍ；（６）心导管检查ＣＩ≤２．０Ｌ／ｍｉｎ·ｍ２并ｍＰＡＰ≥９．５ｋＰａ或ＰＶＲ≥２０００ｄｙｎｅ·ｓ·ｃｍ－５；（７）三瓣膜置换术；（８）瓣膜再次置换术。结果：手术死亡３１例，死亡率１０．１％；远期随访２～９４月（平均３４月），远期死亡率３％／人·年。远期心功能Ⅰ、Ⅱ级２１５例，Ⅲ级１７例，Ⅳ级４例。讨论了手术指征，手术方法和围术期处理。     

非阻塞性输精管滤过装置节育术的精浆中性α-糖苷酶的检测

本文采用ＷＨＯ推荐的改良精浆中性α－糖苷酶的测定方法测定输精管滤过装置节育术（ＩＶＤ组）和输精管结扎术（结扎组）的精浆中性α－糖苷酶活性。术前两组精浆均测出中性α－糖苷酶活性：ＩＶＤ组为４３．５０±２９．０１ｍＵ／每次射精（ｘ±ｓ）；结扎组为４７．８１±３１．２０（ｘ±ｓ）ｍＵ／每次射精；两组间无显著差异（Ｐ＞０．０５）。术后６、１２个月ＩＶＤ组分别有９１．５７％和７９．１７％的精浆测出中性α－糖苷酶活性；而结扎组仅有４．４８％和４．２４％的精浆测出中性α－糖苷酶活性；两组间均有非常显著的差异（Ｐ＜０．００１）。结果提示：ＩＶＤ组术后一年内其大部分受试对象的精浆中仍有附睾液存在。     

碘油阿霉素乳剂导向栓塞化疗治疗中晚期原发性肝癌84例报告

作者自１９８６年以来用碘油阿霉素乳剂（Ａ／Ｌ）导向栓塞化疗治疗中晚期肝癌８４例，并与采用肝动脉或合并门静脉灌注阿霉素的对照组２４例进行比较。结果表明，治疗组症状改善率达８６．１％，ＡＦＰ下降率达７５％，肿瘤缩小率达７９．２％。治疗后平均生存期为１０．３月，明显优于对照组（５．６月）（Ｐ＜０．００１）。半年及１、２、３年累计生存率分别为８９．３％、４３．４％、１３．５％和３．８％，均明显高于对照组（半年５１．２％、１年１１．５％，无２年以上生存者）（Ｐ＜０．０１）。其中３例难以切除之肝癌经本法治疗后获得二期切除，术后生存期明显延长。Ａ／Ｌ灌注后合并明胶海绵中央栓塞的治疗方案可以提高单纯Ａ／Ｌ灌注化疗的疗效。肝癌切除后再插管栓塞化疗不仅可以巩固治疗效果，而且便于观察随访。     

不同手术方法治疗乳糜尿的远期疗效对比观察（附66例报告）

为探讨乳糜尿的较佳治疗方法，采用三种不同的手术方法共治疗乳糜尿６６例，其中采用肾蒂淋巴管结扎术３３例，１４例同时施行肾纤维膜剥落并翻转包裹肾蒂（简称Ａ组）；采用腹股沟淋巴结大隐静脉吻合术１６例（简称Ｂ组）；采用肾蒂淋巴管结扎同时行腹股沟淋巴结大隐静脉吻合术１７例（简称Ｃ组）。结果５３例获得随访，随访时间为２．２￣１４．０年。随访２￣４年，乳糜尿消失率３组分别为７６．０％、５７．１％和９２．３％；随     

无支架异种生物瓣膜主动脉瓣替换术后左室功能变化

评价无支架异种生物瓣膜主动脉瓣替换术后２年左室功能的变化。将８０例同期施行主动脉瓣替换病人分为２组，５０例（年龄６９．３±９．３岁）应用ＴｏｒｏｎｔｏＳＰＶＴＭ瓣；３０例（年龄７１．６±７．７岁）作为对照组接受支架人工瓣膜替换。术前、术后１、６、１２及２４个月间记录Ｍ型及Ｄｏｐｐｌｅｒ超声心动图，采用计算机图像数字分析，定量测定左室功能的变化。随访期间，Ｔｏｒｏｎｔｏ组主动脉瓣跨瓣压差为０．８±０．６ｋＰａ（６．０±４．５ｍｍＨｇ），明显低于对照组２．３±０．９ｋＰａ（１７．３±６．８ｍｍＨｇ）；术后１个月，左室心肌质量下降２５％，左室＋Ｖｃｆ及－Ｖｃｆ明显增加（２．０±０．８／１．４±０．３ｓ－１，Ｐ＜０．０１；２．８±１．２／１．８±０．７ｓ－１，Ｐ＜０．０１）。术后６个月，左室功能进一步改善，心室肥厚的消退更趋完全，该变化在其后的随访期间保持稳定。结论：与支架瓣膜相比，无支架异种生物瓣膜具有较大瓣口开放面积及低跨瓣压差，这促进了术后左室功能的恢复及病理性肥厚的逆转     

尿道会师牵引术治疗后尿道断裂伤的体会

采用尿道会师牵引术治疗后尿道断裂伤４０例。其中１６例按常规方法，牵引１周，牵引力０．５－１．０ｋｇ，置管４周，随访３－８年，７例（４３．７５％）排尿正常，４例（２５．００％）尿线较细，需多次尿道扩张扩张恢复正常，５＊３１．２５％） 道狭窄次手术。２４例改进牵引方法，牵引２周，牵引力在术中称试作牵引，使两粘端恰好对合为度，置管３周，随访０．５－４年，除我除术后因气囊破裂，手术失败外，１９例（７９．１     

腹横纹切口保留睾丸引带阴囊皮下睾丸固定术治疗隐睾症的 …

为了研究治疗先天性隐睾症的最佳术式，以提高隐睾症的治疗水平，采用腹横纹切口保留睾丸引带阴囊皮下睾丸固定术（研究组）治疗隐睾症９６例１１０枚，获得随访者９４例１０８枚，同时采用患侧下腹斜切口肉膜囊睾丸固定术（对照组）治疗隐睾症５０例６２枚。结果研究组睾丸大小及硬度优９４枚，占８７．０％，良９枚，占８．３％，差５枚，占４．６％；睾丸位置优９３枚，占８６．１％，良９枚，占８．３％，差６枚，占５．６％；无     

输精管结扎术后35例再通者排出精子的动态观察

作者观察了输精管结扎术后35例自发性再通者在18个月内精液中精子密度和活动率的动态变化,显示输精管再通者中90.6%发生在术后9月以内,未避孕的再通者夫妇中再孕占1/3,而71.4%的再孕发生在手术一年以后。6例自愿接受再次输精管结扎者术时加用断端电灼或包埋,均在0.5～6月精子完全消失.     

输精管滤过装置节育术的临床研究

本文报告51例输精管腔植入由作者研制的输精管滤过装置与40例钳穿法输精管结扎术经过1至3年的临床比较研究。其结果:两组不同术式的节育有效率均为100％,滤过装置组术后1～3年仍有51.6％(16/31)测出中性α-糖苷酶活性,至今仅有12例附睾轻度肿胀和近附睾段输精管轻度增粗;而结扎组一年后均有不同程度的附睾肿胀和近附睾段输精管增粗,并有1例并发附睾淤积症。两组间有非常显著的统计学差异(P<0.005)。结果提示:输精管滤过装置不仅能限制精子通过而达到节育的目的,又不完全影响附睾液的排出,较好地避免或减少了附睾淤积的发生。因此,有可能作为一种新型的、非阻塞性的男性节育方法用于临床。     

Sites of residual spermatozoa after irrigation of the distal vas deferens using normal saline solution during vasectomy in a rat model

We have previously reported that irrigation of the distal vas deferens using a normal saline solution (NSS) is successful in removing a large amount of spermatozoa from the tract. However, this technique does not completely remove all the motile spermatozoa from the ejaculate. The aim of the present study is to evaluate the location of the residual spermatozoa after distally irrigating the vas deferens. Twenty male Sprague-Dawley rats (400-450 g) constitute our study population. The animals were divided into two groups: group 1, control group (n = 10), rats that undergo only vasectomy and group 2, experimented group (n = 10), rats that undergo vasectomy and distal irrigation of the vas deferens using 3 mL of NSS. In both groups, the middle and terminal parts of the vas deferens including the seminal vesicles are removed and sent for spermatozoa count. The post-vasectomy urine samples containing spermatozoa are obtained by mid-ventral cystocentesis and the concentration is determined using a haemocytometer. More spermatozoa was found in the urine samples of the experimented group than the control (21.3 +/- 10.61 vs. 0.2 +/- 0.20 million/ml, p-value = 0.068), and lesser residual sperms reside at both the middle and the terminal parts of the vas deferens (0.5 +/- 0.31 vs. 3.0 +/- 0.00; p = 0.008 and 1.1 +/- 0.99 vs. 2.0 +/- 0.00; p = 0.036 respectively). No sperms were present in the seminal vesicles of the control group, but two of 10 rats in the experimented group had few to moderate amount of sperms in their seminal vesicles (p = 0.180). After the distal irrigation of the vas deferens using NSS, some residual sperms resided in the middle and more at the distal part of the vas with a few that escaped into the seminal vesicles.     

The vas after vasectomy: comparison of cauterization methods.

A histologic study of the vas ends was carried out in 21 patients undergoing vasovasostomy. All had undergone prior vasectomy by the same surgeon, with a technique identical except for the type of cautery used to seal the vas ends. A superior sealing of the vas, as shown by fewer cases of vasitis nodosa and spermatic granuloma, followed use of the thermal cautery ("red-hot wire") than the electrosurgical cautery (23% vs 60.7% suboptimal sealing rate). The thermal cautery is a superior method of sealing the vas at vasectomy.     

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

AIM: To investigate the morphological changes of spermatozoa in the proximal vas deferens after vasectomy. METHODS: Proximal vas deferens fluids were collected from 79 fertile men (group A) and 64 vasectomized men (group B) during the operations of vasectomy or vasovasostomy. Sperm morphology in the proximal vas deferens was analyzed after staining with the modified Papanicolaou method. RESULTS: The percentage of spermatozoa with a normal oval head from group B (50. 7% +/- 21.7%) was significantly lower than that of group A (75.2% +/- 11.1%). The data in group A was similar to those of normal semen and therefore represents the physiological condition of the proximal vas deferens sperm of fertile men. There were no significant differences in the percentages of normal oval heads in group B with the time since vasectomy. CONCLUSION: After vasectomy, the spermatozoa in the proximal vas deferens and epididymis were continuously degenerating and being replenished by spermatozoa coming from testis. The obvious morphological degeneration occurred in the sperm tail and spermatozoa with a small oval head and amorphous heads were increased.     

Effect of vasectomy via inguinal canal on spermatogenesis in rabbits

Aim： To determine whether vasectomy away from the epididymal tail （via the inguinal canal） in rabbits can reduce the early postoperative effects on spermatogenesis. Methods： Twenty-nine normal male Japanese white rabbits （aged 4- 6 months） were subjected to unilateral close-ended （conventional） or open-ended （the cut end of the juxta-epididymal vas deferens not ligated） vasectomy via the inguinal canal. Ten days and 3 months after operation, testes, epididymides and vasa deferentia were removed and methacrylate resin-embedded sections prepared. The histology of the testis, epididymis and vas deferens was examined under light microscope, and the volume and diameter of the seminiferous tubules were quantitatively studied using stereological methods. Results： Neither of the methods of vasectomy led to apparent damage to spermatogenesis on the vasectomized side in comparison with the contralateral shamoperated side, but the juxta-epididymal vas deferens on the vasectomized side was highly distended and contained numerous sperm 3 months after operation. Conclusion： Vasectomy away from the cauda epididymis has no significant early postoperative effects on spermatogenesis in rabbits.     

Reconstructive microsurgery of the vas deferens. Experimental study of suture materials

Microsurgery is the procedure of choice for vasectomy reversal. The aim of this study was two compare two different suture materials for vasovasectomy - a nonresorbable material (nylon 10/0 with a BV 6 needle), which is widely used, and a resorbable material (polyglycolic acid, also with a BV 6 needle), which has not yet been evaluated for this use. 28 Sprague-Dawley rats were operated on under microscope. Two groups were then compared, group A with nylon (n = 14) and group B with polyglycolic acid (n = 14). In each group, 8 animals had a vas deferens section and 6 had a previous vasectomy by ligature. Ten days postoperatively, the patency rate of the anastomosis was evaluated by the presence of sperm on both sides of the suture line. The contractility was assessed by mechanical stimulation. The existence of a sperm granuloma was considered as indicative of a non functional anastomosis. Three days later a fertility test was performed, lasting three months, and the number of litters was checked. The rats were sacrificed after three months, and each vas deferens was examined histologically or by electron microscope. The macroscopic results were: 57% patent anastomoses in group A and 77% in group B. 16% patent anastomoses after ligature in group A (n = 6) and 75% in group B (n = 6). The pregnancy rate was 54% in group A and 77% in group B. After previous ligation, the corresponding figures were 20% and 83% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)     

腹腔镜原发精囊良性肿瘤切除术的临床应用

目的:探讨腹腔镜原发精囊良性肿瘤切除术的临床经验及手术疗效。方法:回顾分析2005年6月至2010年8月4例原发精囊良性肿瘤患者的临床资料。患者平均(56.5±9.3)岁,囊肿直径平均(6.5±1.5)cm。4例患者均行腹腔镜下精囊肿瘤切除术,3例患侧肿瘤、输精管与精囊一并切除,1例术中将肿瘤完整切除的同时完整保留双侧输精管与精囊。结果:手术均顺利完成,无一例中转开放,围手术期无并发症发生。手术时间平均(81.3±13.1)min,术中出血量<50 ml,术后平均住院(5.8±1.7)d,术后平均随访(47±26.8)个月,患者不适症状消失,勃起及射精功能正常且无局部复发。结论:腹腔镜手术处理盆腔深部的精囊肿瘤视野暴露好、创伤小、患者术后康复快,是治疗原发精囊良性肿瘤安全、可行、有效的微创术式。     

对输精管切除单纯结扎法的商榷

经对449例输精管切除1cm,两断端单纯结扎并加石炭酸烧灼的对象进行了术前和术后0.5至18月的系统精液检查及其配偶的孕情调查,证实输精管自发性再通占7.8％,且其中未避孕的妻子有1/3妊娠。木后18个月的观察结果还表明,90.6％的自发性再通发生在9月以内,而且距手术时间越短发生率相对越高。由于输精管切除1cm,两断端单纯结扎法再通率高达7.8％,故不宜继续采用此法。