输精管绝育术对人群健康远期影响的研究

为评价输精管绝育术对人群健康的远期影响，采用三年一次性回顾结合两年随访的历史前瞻方法，对具有代表性的四川省盐亭县25岁以上（含25岁）男性绝育人群（占20．55％、平均绝育年限15.25年）及未绝育人群（占79.45％）在五年中的死亡、寿命、死因进行了比较研究。结果表明：两类人群平均死亡率为9．02和13．37‰，平均标化死亡率为12．46及12．57‰（u=0．20），期望寿命e_(25)为46．43及45．85岁，e_(70)为11.38及11．06岁；绝育组各主要死因均低于未绝育组，相对危险（OR）均低于1，说明两组人群在总的健康上无差别显著性，绝育术对人群远期健康总的无明显影响。同时，由于某些年龄段绝育组死亡较高、期望寿命较低、死因顺位与未绝育组的不一致及疾病相对危险的差异，不排除绝育对某些疾病存在一定影响，值得进一步研究。     

输精管绝育术与前列腺癌关系的Meta分析

目的：探讨输精管绝育术与前列腺癌的关系。方法：采用Meta分析方法对美国进行的输精管绝育术与前列腺癌关系的七项病例对照研究文献进行综合分析。结果：共收集前列腺癌病人4365例，对照14531例，合并OR＝1．10（95％CI：1．042，1．253），绝育不足20年OR＝0．923（95％CI：0．819，1．390），绝育20年以上者OR＝1．113（95％CI：1．096，1．358）。结论：输精管绝育术与前列腺癌存在一弱阳性联系，并且随着绝育年限的延长发病危险增加。     

输精管绝育术与肺癌死亡率的关系

目的：探讨输精管绝育术与肺癌的关系。方法:对盐亭县40-70岁男性进行三年回顾及两年随访调查，及队列内1：2肺癌病例对照研究。采用Poisson回归及条件Logistic回归进行资料进行分析。结果：绝育人群中，绝育不足10年者肺癌死亡危险明显于绝育20年以上者RR=0.17(95%CI:0.34-0.35)，随着绝育时年龄的增加肺癌死亡危险增加，和40岁后绝育者相比30-39岁、30岁以前绝育者相对危险分别为0.83（95％CI:0.02-0.36)、0.16（95%CI:0.08-0.34).1-2病历对照研究发现绝育年限、绝育时年龄对肺癌死亡无影响。结论：肺癌死亡率在绝育人群和未绝育人群间差异无显著性，但早期绝育可能有助于降低其死亡率。     

高血压与中心性肥胖对心脑血管疾病的联合作用

目的 探讨高血压合并中心性肥胖患者心脑血管疾病的发病危险性。方法 采用横断面调查的方法,于2016年3~4月期间,共调查苏州市高新区常住居民9 984人,收集其人口统计学、疾病史以及生活方式资料,并进行体格检查以及生化指标检查。采用Logistic回归模型分析高血压合并中心性肥胖与心脑血管疾病的关系。结果 在9 984名研究对象中,患心脑血管疾病者共396人（患病率3.97%）,其中冠心病243人（患病率为2.43%）,脑卒中178人（患病率为1.78%）。经多因素调整后,与腰围及血压均正常者相比,高血压合并中心性肥胖者患脑卒中、冠心病以及心脑血管疾病的OR及95%CI值分别为3.10（1.78~5.40）,2.56（1.61~4.07）和3.06（2.10~4.45）（均有P<0.05）。结论 高血压合并中心性肥胖可能会增加心脑血管疾病的患病风险。     

输精管绝育后经皮穿刺吸精子IUI辅助授孕技术临床研究

应用经皮穿刺输精管精子（PVSA）及经皮穿刺附睾吸精子（PESA）宫腔内人工授精（IUI）技术，治疗男性绝育后术后要求复育或复通复育失败者共28例。其中PVSA16例，IUI16个月经周期，6例妊娠，周期妊娠率37．5％；其余12个列由于吻合术输精管与周围组织粘连严重采用PESA，4例从附睾尾吸出精子，IUI后1例妊娠并足月出生一健康男婴；8例从附睾头吸出活精子，IUI10个月经周期，1例妊娠，现已4个月，结论认为，附睾头部精子进入女性生殖道内具有自然受精能力；PESA或PVSA结合IUI治疗男性绝育术后要求复育者安全、经济、有效，其辅助授孕技术为男性绝育术后复育提供了新的途径。     

输精管结扎后残端皮下粘连10例治疗体会

输精管结扎术为男性绝育术中最常用而又简便、安全有效的方法之一。术后致输精管残端皮下粘连，也偶有所见，我院及计生站白1996年1月至2004年12月共收治10例。现将治疗及预防方法报告如下：     

临沂市部分35岁以上农村居民高血压、冠心病、脑卒中患病情况调查

[目的]了解农村人群高血压、冠心病、脑卒中的现患水平,分析其主要危险因素,为防治对策提供科学依据。[方法]2004年,在临沂市分层整群抽取费县、蒙阴县、平邑县、沂水县、沂南县部分35岁以上人群进行调查。[结果]调查8 086人,高血压患病率为17.29%,脑卒中患病率为0.59%,冠心病患病率为0.87%。高血压、冠心病患病率均在55岁以上明显上升,脑卒中患病率在65岁以上明显上升,均随年龄增长而上升（P〈0.01）;超重者高血压患病率较高,高血压者脑卒中、冠心病患病率较高。[结论]肥胖、超重是高血压的危险因素,高血压是冠心病、脑卒中的危险因素。     

近端开放输精管绝育术361例临床研究

<正> 输精管绝育术以其方法简单,操作容易,效果可靠在计划生育工作中发挥了重要作用。在众多方法中,以直视钳穿法输精管结扎术使用最为广泛。1980年1月～1986年2月我们施行利用人体自身组织将切断的输精管远、近端隔开的男性绝育术361例。手术由专人施行,标准统一。经术后观察及远期随访,效果满意,现介绍如下。     

五种疾病被误诊为输精管绝育术后并发症的原因和教训

<正> 输精管绝育术后并发泌尿生殖系感染、痛性结节、附睾瘀积症的诊断并非十分困难。但一些疾病的临床表现酷似这些术后并发症,若不系统全面地询问病史和进行体格检查,常易造成误诊。我中心于1989年3月～1995年12月共收治输精管绝育术后并发症133例,有五种疾病共12例被误诊为绝育术后并发症。其中5例慢性前列腺炎和1例肾及尿路结石并肾盂肾炎误诊为绝育术后尿路感染,精索静脉曲张误诊     

男性绝育术后597例随访分析

<正> 随州市计划生育服务站对1988年以来施行男性绝育术的对象进行了一次随机抽样调查,采用逐人登记、查问、检查的方法,调查其手术方式、术后反应,现就调查结果总结如下。一、对象与方法1.调查对象为1988～1992年实行男性绝育者597例,其中农民594例,教师3例。2.手术方式输精管药物粘堵术205例,栓堵术173例,直视钳穿术120例,传统结扎术99例。粘堵术、栓堵术及钳     

Long-term effect of vasectomy on coronary heart disease

We investigated the association between coronary heart disease (CHD) and vasectomy in a population of 10,632 men who were under surveillance for multiple CHD risk factors during participation in a university-based exercise testing program. We conducted a mail survey with telephone follow-up to determine the vasectomy status of individuals in the population. Responses were obtained from 6,159 individuals. The 4.944 males on whom information was complete enough to be included in the multivariate analysis comprised the study population. Among the 1,383 (28 per cent) vasectomized males in the study populations, the interval from vasectomy to the time of the survey ranged from less than one year to 37 years with a mean duration of 15 years. Although increased relative risks for CHD were found to be associated with family history of CHD, high blood pressure and smoking in this population, the relative risk of CHD associated with vasectomy was not increased in general, nor was it increased when the vasectomized males were classified by time since vasectomy. Likewise, serum antisperm-antibody titers were not predictive of CHD among vasectomized men. These studies support the findings from previous investigations of populations with shorter average post-vasectomy experience in which vasectomy has been shown to be unassociated with altered risk of CHD in humans.     

输精管结扎对血清T、DHT、LH和FSH的远期及超远期影响

为了解输精管结扎对血清T、DHT、LH和FSH的远期及超远期影响,对91例结扎10年以上男性和91例同龄的非结扎男性进行了配对研究。结果发现,结扎年数(VY)<20年男性的DHT高于同龄对照组(1.46/1.22μmol/L,P<0.01),T无显著差别,T/DHT低于同龄对照组(14.5/20.1μmol/L,P<0.05).VY≥20年男性的T高于对龄同照组(27.2/23.9μmol/L,P<0.05),DHT和T/DHT无差别,以上两个年龄亚组的LH、FSH比较均无明显差别。     

Vasectomy and health: cardiovascular and other diseases following vasectomy in Sichuan province, People's Republic of China

The long-term sequelae of vasectomy were studied in a retrospective cohort study of 4596 vasectomized and 4340 nonvasectomized farmers from eight rural communes in Sichuan, People's Republic of China. The mean duration since the operation was 14.5 years with a range of 10 to 25 years. At the time of evaluation the vasectomized men were generally healthier than the non-vasectomized for a wide range of health indicators including clinical signs of cardiovascular disease, resting ECG changes, positive ECG changes following a maximal stress test, or fundus abnormalities. The lack of association between vasectomy and cardiovascular disease noted in Europe and the USA is supported by the present study conducted in a population with a low prevalence of cardiovascular disease and risk factors.     

The relationship between vasectomy and angiographically determined atherosclerosis in men

Long-term prospective studies in monkeys have shown that vasectomy is associated with an increase in atherosclerotic disease. The purpose of the present investigation is to evaluate whether vasectomy in men is associated with atherosclerotic disease in the coronary arteries. In this study information was obtained on the vasectomy status in a series of 7,420 men who had previously been referred for coronary angiography because of cardiovascular symptomatology and have been followed for as long as 9 years to evaluate coronary artery bypass surgery and the natural history of the disease. It was found that 5.0% had a vasectomy prior to angiography. Two different data analysis procedures were used to determine whether the vasectomized men had a greater degree of angiographically determined coronary occlusive disease than the nonvasectomized men. Subgroups with minimal and extensive coronary artery disease were also analyzed. Results of all analyses show that the vasectomized men did not have more coronary occlusive disease. Possible patient selection biases in this study are discussed.     

The vasectomy decision-making process

Vasectomy is greatly underutilized in most countries, in part because it is the least promoted of all modern contraceptive techniques. If providers have favorable attitudes toward vasectomy, a good understanding of the decision making process that leads to vasectomy enhances their ability to encourage the use of this method. Furthermore, thorough counseling of vasectomy seekers will significantly increase acceptance. The purpose of this article is to define the decision making process and to discuss how this information can be used in family planning programs. An in-depth study was made of the decision making processes of 235 couples using the counseling services of the Planned Parenthood Association of Houston, Texas, in order to understand the decision making process. The process took from 2 to more than 10 years and has the following events in common: became aware of vasectomy; talked to a vasectomized man; decided to have no more children; decided temporary contraceptives were no longer acceptable; decided vasectomy was the best contraceptive method; had a scare (a missed period or severe side effects from the pill). Information gathering by acceptors occurred throughout the process, with men faltering on the way toward vasectomy because they lacked information from an influential source, not because they had been exposed to a casual dose of misinformation. Sources questioned include physicians (usually gave incomplete answers); reading material (less than 50% used this source); vasectomized men (9 out of 10 used this source and felt it to be most influential). Questions most men ask are listed in the article. Guidelines for counselling are suggested. Specific suggestions for program administrators are offered, based on the 5 phases most men pass through before getting a vasectomy. Phase 5, when a decision is made, is the best time for an information and education program through the mass media. Other stages suggest capitalizing on the presence of vasectomized men in their communities and in-depth media campaigns.     

输精管绝育术后经皮穿刺吸精子IUI辅助授孕技术临床研究

应用经皮穿刺输精管吸精子(PVSA)及经皮穿刺附睾吸精子(PESA)宫腔内人工授精(IUI)技术,治疗男性绝育术后要求复育或复通复育失败者共28例。其中PVSA 16例,IUI 16个月经周期,6例妊娠,周期妊娠率37.5％;其余12例由于吻合术后输精管与周围组织粘连严重采用PESA,4例从附睾尾吸出精子,IUI后1例妊娠并足月出生一健康男婴;8例从附睾头吸出活精子,IUI 10个月经周期,1例妊娠,现已4个月。结论认为,附睾头部精子进入女性生殖道内具有自然受精能力;PESA或PVSA结合IUI治疗男性绝育术后要求复育者安全、经济、有效,其辅助授孕技术为男性绝育术后复育提供了新的途径。     

Restoration of fertility in vasectomized men using percutaneous vasal or epididymal sperm aspiration

OBJECTIVE: To restore fertility of vasectomized men using percutaneous epididymal sperm aspiration (PESA) and percutaneous vasal sperm aspiration (PVSA) via intrauterine insemination (IUI). PATIENTS: Twenty-eight vasectomized men who required restoration of their fertility with PESA, PVSA and IUI. RESULTS: Of 28 vasectomy reversal subjects, 16 cycles of IUI using vasal sperm by percutaneous aspiration were performed in 16 subjects and 6 pregnancies were achieved. IUIs with epididymal sperm by percutaneous aspiration were carried out in 12 subjects with epididymal obstruction due to vasovasostomy for vasectomy reversal, and 2 pregnancies were achieved using caudal and epididymal sperm by percutaneous aspiration, respectively. CONCLUSION: The PESA-IUI and PVSA-IUI techniques are attractive, economical and effective for vasectomy reversal. The pregnancy by IUI using PESA and PVSA reveals that the caput epididymal sperm possess fertilization capacity in female reproductive tract and provides a new approach for the restorative fertility of vasectomized men.     

A comprehensive review of the sequelae of male sterilization

This study of the sequelae of vasectomy considers morphological and immunological changes, epidemiological studies, reversibility, and psychological aspects. The data on morphological changes after vasectomy are diverse and contradictory, as a wide range of experimental animals have been studied. The number of studies on men has been limited, but they suggest little histologic change in testicular morphology or spermatogenesis. Hormonal changes after vasectomy are difficult to assess because of the large fluctuations in semen levels of testosterone and gonadotropins. Most of the studies on this topic have been small and have lacked controls, with comparisons consisting of pre-post differences in the same subject group. The only prospective controlled study found no differences between vasectomized and control subjects on any of the hormones investigated. 2 large-scale studies have also produced conflicting results; 1 found no changes in hormone levels, and the other found that only follicle stimulating hormone levels did not change. It is apparent from the studies that any hormonal fluctuations after vasectomy remain within the normal range, and it has not been demonstrated that testicular endocrine function or the relationship of the pituitary to the testis are in any way adversely affected by vasectomy. It has been shown that after vasectomy 50-60% of men develop sperm agglutizating antibodies while 20-30% develop sperm immobilizing antibodies. The implications are 1) that if some of the antibodies are nonspecific or cross-reacting, the incidence of autoimmune disease may be increased in vasectomized men; and 2) the persistence of sperm antibodies may cause failure of reversal attempts despite anatomical patency. Studies of the incidence of atherosclerosis in vasectomized monkeys showed that they developed antisperm antibodies and much more extensive atherosclerosis than controls, causing concern because of the phylogenic closeness of monkeys to man. Epidemiologic studies as yet furnish insufficient evidence to extrapolate findings on postvasectomy atherosclerotic lesions in monkeys to man. There is no clinical evidence after several large studies to show that vasectomy is harmful to the circulatory system in man, but surveillance of men who have undergone vasectomy is indicated. Pregnancy rates after reversal attempts are not as high as success rates in terms of canalization and sperm appearance in the ejaculate, but it is not yet known what causes the difference. No adverse psychological effects of vasectomy have been demonstrated in developed countries, and the high incidence of regret and other psychological effects in developing countries may be due to a lack of truly voluntary consent.     

Immunological Consequences of Vasectomy: I. Prospective Study through One-Year Postvasectomy

Autoimmunity to sperm developed in two-thirds of men within 1 year after vasectomy as measured by sperm agglutinating and sperm immobilizing antibody tests. Sperm antibody responses to vasectomy were greater in younger than in older men. A direct relationship was apparent between increasing incidence of sperm immobilizing antibody and genetic predisposition to autoimmune disease. Some vasectomized men developed immune responses to autoantigens other than spermatozoa. Increased antithyroglobulin activity was evenly divided between patients who formed sperm antibody and those who did not. Antinuclear activity was more frequent in patients who were sperm antibody responders.     

输精管结扎术后人群的死亡和寿命研究

采用一次性调查和现时寿命表方法，研究输精管结扎与未结扎人群的死亡和寿命。结果表明：２５岁以后的两类人群年标化死亡率分别为６．７４％及１３．６１％。结扎人群寿命表生存人数高、６０岁前死亡人数及死亡概率低，期望寿命２５和６０相差１２．９９岁及１１．９０岁。全人群与未结扎人群平均期望寿命０相差１．０７岁（ＣｈｉａｎｇＣ．Ｌ．法）。说明结扎人群健康明显优于未结扎者。另外，研究也表明结扎人群死亡人数及死亡概率在６０～６４岁组超过了未扎人群，值得进一步研究。