别嘌呤醇对睾丸扭转的治疗作用

目的 研究睾丸扭转以后组织的受损情况，观察别嘌呤醇药物对睾丸扭转的治疗意义。方法 以大鼠为研究对象，测定一侧睾丸扭转后两侧睾丸组织的脂质过氧化物含量。按扭转时间分组，分析睾丸扭转、复位、药物应用以后局部的损伤变化情况。结果 单侧睾丸扭转以后，两侧组织的脂质过氧化物含量都明显上升。脂质过氧化物的含量与扭转时间有关。别嘌呤醇应用后，能降低扭转2h以内的两侧睾丸脂质过氧化物产量，以及扭转6h以内的对侧睾丸脂质过氧化物含量。结论 别嘌呤醇对改善睾丸扭转损伤有治疗意义，临床上应提倡早期用药。     

单侧睾丸扭转后患侧和对侧睾丸的生化改变

单侧睾丸扭转后患侧和对侧睾丸的生化改变文献报道，实验组织病理学和临床生育研究显示单侧睾丸扭转后对侧睾丸亦受损害。对侧睾丸损害的原因有多种解释，但真正机理尚不清楚。最近电磁和放射性同位素血流测定显示，单侧睾丸扭转后引起对侧血流减少，扭转复位后血流逐渐增...     

西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究

目的 探讨大鼠单侧睾丸扭转后对侧睾丸的损伤以及西地那非（万艾可）的保护机理.方法 将72只健康雄性SD大鼠,随机分为假手术组、安慰剂组、西地那非组.3组分别在假手术/左侧睾丸扭转复位术后4 h、24 h、2周时,各组各处死8只大鼠.分别观察右侧睾丸组织病理学变化、测定右侧睾丸组织中MDA、NO/NOS含量.结果 术后4 h,各组间组织病理学变化、MDA、NOS含量无明显差异,睾丸组织未见损伤,但NO在两地那非组较假手术组、安慰剂组明显增加（P〈0.05）.术后24 h,假手术组右侧睾丸组织损伤最小,西地那非组较严重,安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量明显升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）;术后2周时,睾丸组织损伤有不同程度恢复,但仍以安慰剂组最为严重;与假手术组比,其余两组MDA、NO/NOS含量仍然升高（P〈0.05）;西地那非组NO/NOS含量与安慰剂组相比明显下降（P〈0.05）.结论 大鼠单侧睾丸扭转复位后,对侧睾丸组织术后4 h时.睾丸组织未见损伤.12 h后睾丸组织明显损伤,并且持续至2周后.早期应用适量西地那非（万艾可）可促局部NO增加,扩血管作用加强,拮抗交感神经缩血管作用,进而保护对侧睾丸.     

青春期前大鼠睾丸扭转生精功能损伤与Fas/FasL mRNA的表达

单侧睾丸扭转（unilateral testicular totsion,UTT）好发于青春期前小儿，即使手术复位后仍可能出现生精功能长期受损，并造成成年男子不育。单侧睾丸扭转影响生精功能的机制较为复杂，缺血／再灌注损伤是患侧睾丸生精功能受损的主要原因之一，凋亡调控基因亦参与其中。本实验通过建立青春期前大鼠睾丸扭转模型，研究大鼠睾丸扭转复位后患侧睾丸生精功能损伤的分子机制。     

不同日龄隐睾复位大鼠睾丸组织结构观察

目的 观察不同13龄隐睾复位大鼠睾丸组织结构的变化.方法 72只21 d雄性SD大鼠随机分为单侧隐睾组、双侧隐睾组、假手术对照组各24只.建立单、双侧隐睾动物模型.2周后行隐睾大鼠睾丸下降固定术,于日龄40、60 d处死取睾丸,采用苏木素.伊红染色光镜下观察各组大鼠精曲小管生育力指数(TFI)和平均精曲小管直径(MTD);生物素-dUTP/酶标亲和素法(TUNEL法)检测睾丸生殖细胞凋亡情况.结果 隐睾侧睾丸MTD、TFI显著低于阴囊内睾丸,而隐睾生殖细胞凋亡指数(AI)明显增高于阴囊内睾丸(P＜0.05);单侧隐睾组阴囊内睾丸TFI低于相应日龄的假手术对照组,但无统计学意义(P＞0.05).40 d时单侧隐睾组隐睾侧睾丸生殖细胞AI较双侧隐睾组低(P＜0.05),日龄60 d,各组隐睾侧睾丸AI较40 d时明显降低(P＜0.05),但单侧隐睾和双侧隐睾AI比较无统计学差异(P＞0.05).结论 实验隐睾复位大鼠睾丸AI升高,同时单侧隐睾鼠对侧睾丸组织存在不同程度的损害.随着复位时间的延长,隐睾组织的病理损害有恢复的趋势.     

大鼠睾丸扭转复位及减压治疗对睾丸的影响

目的 研究睾丸扭转复位及减压治疗对睾丸的影响,为睾丸扭转的预后判断、治疗方法的选择等提供新的理论依据.方法 将30只SD雄性大鼠随机分成5组,制成睾丸扭转复位及复位+减压治疗的模型.分别设立空白对照组及实验A～D组,睾丸扭转/复位组(A组)、睾丸扭转/复位+减压治疗组(B组)喂养至术后1 d处死;睾丸扭转/复化组(C组)、睾丸扭转/复位+减压治疗组(D组)喂养至术后1个月处死.应用化学检测和组织学分析方法,观察睾丸大体标本的变化、睾丸组织内丙二醛(MDA)含量的变化及睾丸组织Johnsen's评分.结果 五组睾丸MDA分别为3.18±0.22(空白对照组)、9.54±2.05(A组)、7.92±1.38(B组)、6.67±0.61(C组)、4.30±1.81(D组),实验组术侧睾丸的MDA含量显著高于自身对侧(P<0.05).D组MDA含量比C组明显下降(P<0.05).单纯复位组的术后睾丸标本比自身对侧和减压治疗组有明显萎缩;五组Johnsen's评分分别为10±0、7.2±0.18、8.2±0.19、2.2±0.19、9.2±0.18.D组比C组明显提高(P<0.05).结论 睾丸扭转复位+减压治疗能明显减少扭转侧睾丸生殖细胞凋亡,减轻脂质过氧化程度,可能有利于睾丸组织结构与功能的恢复.     

自由基清除剂预防环磷酰胺致大鼠性腺损伤的实验研究

应用自由基清除剂维生素Ｅ、维生素Ｃ和别嘌呤醇预防环磷酰胺（ＣＴＸ）所致大鼠性腺损伤。结果显示，两性预防组大鼠血和性腺组织中的丙二醛（ＭＤＡ）及超氧化物歧化酶（ＳＯＤ）分别明显低于和高于ＣＴＸ组；电镜下，预防组大鼠睾丸精子细胞线粒体增多，空泡化明显轻于ＣＴＸ组；睾丸、附睾头体重量及精子数、睾丸日产精子数和大鼠产仔数，预防组均明显高于ＣＴＸ组，而胚胎吸收数则明显低于ＣＴＸ组。表明维生素Ｅ、维生素Ｃ和别嘌呤醇等自由基清除剂对ＣＴＸ所致的性腺损伤有一定的预防作用，在一定程度上能保护大鼠精子的发生和成熟，使其生殖功能维持在一定水平。     

生脉注射液对青春前期大鼠睾丸扭转/复位缺血再灌注的保护作用

目的观察青春前期大鼠睾丸单侧扭转复位后对双侧睾丸氧自由基的远期影响,探讨生脉注射液对其的保护作用。方法 5周龄健康SD雄性大鼠24只,随机分为实验组(生脉注射液组)、对照组(9 g.L-1盐水组)和假手术组,每组8只。实验组和对照组建立左侧睾丸扭转复位模型,假手术组游离睾丸,不予扭转。于术后7周取各组大鼠双侧睾丸,分别测定大鼠睾丸组织内超氧化物歧化酶(SOD)、一氧化氮合酶(NOS)活性和丙二醛(MDA)水平。结果与对照组比较,实验组和假手术组大鼠双侧睾丸中SOD活性升高,NOS活性和MDA水平下降(Pa<0.05)。与假手术组比较,实验组大鼠双侧睾丸组织中SOD活性下降,NOS活性和MDA水平升高(Pa<0.05)。结论生脉注射液可提高大鼠睾丸组织中的SOD活性,提高机体抗氧化能力,清除氧自由基,抑制脂质过氧化反应,减轻MDA对细胞膜的损伤,对睾丸缺血再灌注损伤具有一定的保护作用。     

睾丸扭转26例临床分析

目的：总结睾丸扭转的诊断及治疗。方法：对26例睾丸扭转的临床资料作回顾性分析。结果：8例扭转时间短或扭转＜180度者经手术复位，保留睾丸；18例睾丸因扭转时间长或完全旋转而坏死予以切除。结论：Doppler超声听诊仪和彩色Doppler超声成像是诊断急性睾丸扭转的可靠依据，治疗是应及时诊断、及时复位、切除坏死睾丸，并将双侧睾丸同时作预防性固定，以免复发或对侧再发。     

褪黑激素对大鼠睾丸扭转缺血和再灌注损伤的保护作用

目的 探讨褪黑激素对大鼠睾丸扭转的治疗作用.方法 选取青春期雄性SD大鼠48只,随机分为3组:空白对照组(A组);扭转复位组(B组);扭转复位+褪黑激素组(C组).B组和C组大鼠建立睾丸扭转复位模型,对照组不扭转.扭转4h后复位睾丸,复位前15 min B组腹腔注射生理盐水1 ml:C组腹腔注射褪黑激素1ml(17 mg/kg).复位后4h处死所有动物取睾丸待测.以原位缺口末端标记法(TUNEL)检测生精细胞凋亡指数;化学比色法测定睾丸组织内总抗氧化能力(T-AOC).结果 B组T-A0C( 20.31±2.55)U/mg比A组(33.62±3.29) U/mg明显降低,差异有统计学意义(P＜0.01).而C组T-AOC(30.05±2.08)U/mg较B组明显升高(P＜0.05).B组凋亡指数(42.2±3.21)％明显高于A组(5 7±0.67)％(P＜0.01),而C组凋亡指数(12.2±1.34)％较B组显著下降(P＜0.05).结论 褪黑激素具有明显对抗睾丸扭转复位后的氧化损伤,对因睾丸扭转导致的缺血再灌注损伤具有保护作用.     

Management of undescended testis

The term cryptorchidism indicates a testis, which has failed to descend to the scrotum and is located at any point along the normal path of descent or at an ectopic site. Hormones play a pivotal role in testicular descent except during the migration to the level of internal inguinal ring. Cryptorchidism is present in about 4.5% of newborns with a higher incidence in preterms. The incidence decreases to 1.2% by the first year. It is classified as palpable and impalpable. The most common site of an ectopic testis is superficial inguinal pouch. Retractile testis is often bilateral and most common in boys between 5 and 6 years of age. Hypospadias and inguinal hernias are the most common associated anomalies seen with undescended testis. A thorough clinical examination helps in arriving at the etiology. A short hCG stimulation test helps to exclude anorchia. Different imaging techniques are of little help in diagnosis and require the help of an experienced radiologist. Laparoscopy has an important role in the diagnosis and management of undescended testis. The common complications include torsion and atrophy of testis. Infertility is seen in about 40% of unilateral and 70% of bilateral cryptorchidism. Undescended testis is 20 to 40 times more likely to undergo malignant transformation than normal testis. Both hCG and GnRH have been used with limited success in these children. All boys with cryptorchidism should be referred to a pediatric surgeon before 2 years of age. These children should be followed up every year after surgery to identify testicular tumors.     

The vanishing testis

Surgical exploration of 417 clinically impalpable cryptorchid testes revealed 84 (20%) instances of absent testes. Thirty-five (42%) of the 84 explorations showed complete absence of the testes along with the epididymis and vas, whereas 49 (58%) were associated with blind-ending cord structures: the vanishing testis syndrome. The presence of a vas deferens and vessels lying side by side in the inguinal canal strongly suggests that a testis existed at one time and subsequently vanished, probably as a result of antenatal vascular accident. The incidence of vanishing testes in our patients was higher than the true congenital absence of testis including vas deferns and epididymis. Offprint requests to: P. Puri at the above address     

The ascending testis

This study relates the timing and incidence of orchidopexy to possible ascent of the testis. During 1985, 341 patients underwent surgery for undescended testes at the Royal Children's Hospital, Melbourne. In 85 (25%), surgery was performed before 2 years of age. The number of children managed surgically over the age of 2 years is high (75%) despite our surgical policy to perform orchidopexy at 2 years of age. Statistical analysis shows a bimodal distribution for age at the time of surgery for undescended testis, with 16% of the orchidopexy population in the older age group. It also demonstrates that the overall orchidopexy rate of 2.6% is three times the expected incidence of undescended testes at 1 year of age. Possible explanations for these observations include: (1) the diagnosis and referral of undescended testis is being made late; (2) surgery is being performed on retractile testes; or (3) some later presenting undescended testes are acquired, the so-called ascending testes. Offprint requests to: A. A. Woodward     

The undescended testis

Testicular development is determined by the influence of the SRY gene on the Y chromosome of the fetus. This influences the germ cells to produce testosterone and Mullerian inhibiting substance which control descent of the testis. Maldescent of the testis occurs in 0.8% of boys. Current best advice is to perform orchidopexy before the age of two years, therefore a programme for examination by skilled healthcare workers should be established in the first year of life. Indications for surgery include a possible beneficial effect on fertility, malignant potential particularly if intra-abdominal, torsion or trauma and social considerations. Hormonal treatment in the first three months of life is recommended by some. Laparoscopy is the optimum method for evaluating and managing the intra-abdominal testis.