无精子症外科取精术120例护理配合

目的:探讨无精子症患者实施外科取精术的护理配合方法及效果。方法:对120例无精子症患者实施外科取精术,给予良好的护理配合,观察效果。结果:本组61例患者获得精子,外科取精阳性率50.83%。外科取精术后进行加压包扎及抗感染治疗3 d,无感染及阴囊血肿等并发症发生。结论:对无精子症行外科取精术患者实施良好的护理配合,可促进患者积极配合手术,减少术后并发症,提高取精成功率。     

非梗阻性无精子症患者显微镜下睾丸切开取精术后疼痛的相关因素分析及护理对策

目的：探讨非梗阻性无精子症(NOA)患者显微镜下睾丸切开取精术后疼痛相关影响因素,寻找对应的护理对策。方法：采用回顾性调查,对2017年4月1日～2019年7月31日收治的179例行显微镜下睾丸切开取精术的NOA患者进行资料分析,并以术后疼痛持续>1 d的108例为观察组,术后疼痛在1 d内得到控制缓解的71例为对照组,并对其进行单因素分析、Logistic回归分析及ROC曲线分析;分析NOA患者显微镜下睾丸切开取精术后疼痛相关影响因素,并提出对应的护理策略。结果：单因素分析分析结果显示,两组手术时间、手术位置、是否成功取得精子比较差异有统计学意义(P<0.05);Logistic回归分析结果显示：手术位置、是否成功取得精子为导致NOA患者显微镜下睾丸切开取精术后疼痛的独立影响因素;ROC曲线分析结果显示：上述影响因素曲线下面积分别为0.606、0.617,敏感性较高。结论：NOA患者显微镜下睾丸切开取精术后疼痛可能与手术位置、是否成功取得精子有关,故护理中应继续优化术后护理流程,强化疼痛干预策略,提升临床治疗效果。     

2种类型非梗阻性无精子症患者行显微睾丸取精术联合辅助生殖技术助孕结局分析

目的 比较特发性非梗阻性无精子症(idiopathic non-obstructive azoospermia,iNOA)、纯合型克氏综合征患者行显微镜下睾丸取精术(microdissection testicular sperm extraction,micro-TESE),配偶同周期行卵胞质内单精子显微注射技术(i...     

梗阻性无精子症的外科治疗

目的探讨梗阻性无精子症的外科治疗方法及效果。方法对30例梗阻性无精子症患者,根据其病因分别采取输精管-输精管吻合术、输精管-附睾管吻合术、输精管-输精管吻合术加对侧输精管-附睾管吻合术。术后6mo及1a末检查患者精子的排出情况,并比较3组手术的效果。结果术后6mo末患者精子出现率73%,精子正常率40%;29%的患者精子运动率>30%;输精管端端吻合术后精子出现率62%,输精管附睾吻合术后精子出现率40%,两组比较差异有极显著性(P<0.01)。结论梗阻性无精子症的外科治疗方法简便、经济,效果较好。     

非梗阻性无精子症的临床诊断

自1992年卵细胞质内单精子注射(intracytoplasmic sperm injection,ICSI)技术开始应用于临床以来,为无精子症患者的不育治疗带来了希望。梗阻性无精子症(OA)再通手术失败或没有手术指征的患者,获取附睾和睾丸精子后可进行ICSI。1993年,Craft等[1]首次报道了在非梗阻性无精子症     

无精子症患者睾丸体积与睾丸抽吸取精术穿刺结果的相关性分析

目的探讨无精子症患者睾丸体积与睾丸抽吸取精术(TESA)穿刺结果的相关性,了解TESA获取精子与严重少弱精子症两者卵胞浆内单精子显微注射技术(ICSI)助孕患者的妊娠率的差异。方法回顾性收集129例于2016年8月至2018年9月就诊于青海省红十字医院及青海省人民医院生殖中心无精子症患者的一般资料、睾丸大小、治疗情况等。按睾丸体积大小分为A组15例(睾丸体积≤12 ml)、B组29例(睾丸体积=15 ml)和C组85例(睾丸体积≥20 ml)。对3组间找到精子的比例进行对比分析。对行ICSI助孕的患者,根据精子来源于TESA患者或严重少弱精子症的患者的不同分为TESA组(16例)和ICSI组(21例),对两组患者的妊娠率进行对比分析。结果在A、B、C 3组患者中,A组只有1例患者找到精子,占该组患者的7. 14%; B组共有7例患者找到精子,占该组患者31. 82%; C组共有39例患者找到精子,占该组患者的84. 78%。C组患者中找到精子的比率最高,与A组和C组比较,差异具有统计学意义(P 0. 01)。A组和B组比较,B组患者找到精子的比率较高,差异具有统计学意义(P 0. 05)。ICSI组患者与TESA组患者的妊娠率比较差异无统计学意义(P 0. 05),ICSI组、TESA组妊娠率分别为42. 86%(9/21)、50. 00%(8/16)。结论在无精子症患者中,睾丸体积≤12 ml者在行TESA时找到精子的比率很低,睾丸体积=15 ml者行TESA找到精子的比率较大,而睾丸体积≥20 ml者行TESA找到精子的比率很大。TESA时找到精子与严重少弱精子症患者行ICSI助孕时并不影响其妊娠率。     

非梗阻性无精症患者睾丸显微取精行ICSI助孕后临床结局以及安全性探索研究

目的探索研究非梗阻性无精症患者睾丸显微取精后行卵泡浆内单精子注射(ICSI)的临床结局以及安全性。方法选取我院男性不育科2017年1月～2018年6月接受ICSI治疗的65个周期进行回顾性分析,将65个周期分为3组,治疗组(睾丸显微取精组)25个周期,对照组1(睾丸穿刺组)20个周期,对照组2(严重少弱精组)20个周期,对这3组的受精、胚胎、妊娠情况进行比较。结果治疗组、对照组1及对照组2每个周期受精卵数、卵裂胚数、移植胚胎数、优质胚胎数、临床妊娠率、自然流产率、抱婴率等无统计学差异。结论对于非梗阻性无精症患者而言,睾丸显微取精(M-TESE)目前是一种既安全又有效的治疗手段,在ICSI助孕后对辅助生殖临床结局没有影响。     

睾丸融合症1例行显微外科取精术及护理

对1例睾丸融合症合并非梗阻性无精子症患者实施在显微镜下睾丸切开取精术,给予良好的护理配合及围手术期的护理。成功取得了含有精子的睾丸组织。外科取精术后进行加压包扎及抗感染治疗3d,未出现伤口感染及阴囊血肿等并发症的发生。对睾丸融合症合并非梗阻性无精子症患者实施良好的护理配合,可促进患者积极的配合手术,依从性增高,从而减少术后并发症的发生,提高取精成功率。     

73例睾丸切开显微取精患者的护理体会

对73例行睾丸切开显微取精的患者进行回顾性总结。护理措施包括术前准备、心理护理、术中配合、术后护理及追踪随访;73例行睾丸切开显微取精患者术后随访无并发症,49例进入ICSI周期,妊娠40例,出生10例;积极充分的术前准备和心理护理、术后预防和追踪随访对手术的实施和术后康复有重要的意义。     

非梗阻性无精子症患者X染色体连锁的TEX11基因多态性研究

目的明确潮州地区男性非梗阻性无精子症患者X染色体连锁的TEX11基因多态性类型及其频率。方法从2012年6月至2018年5月来本院泌尿外科和生殖医学科就诊的患者中收集到217例无精子症患者血液样本,列为实验组的35例患者符合非梗阻性无精子症的诊断标准,以生精(生育能力)正常男性为对照组,应用多重聚合酶链反应(PCR)技术对实验组和对照组的TEX11基因进行扩增,并通过基因测序检测TEX11基因多态性情况,采用Chromas软件、Nucleotide BLAST数据库分析比对基因测序结果,对TEX11基因多态性的位点和类型进行统计。结果实验组TEX11外显子错义突变点有2处,分别是Exon 7:c.389 A>G,突变率37.1%;Exon 17:c.1351 G>A,突变率8.6%。对照组中发现Exon7、Exon 17也有相同位点突变,突变率分别为:37.5%、8.3%。2组之间差异无统计学意义(P>0.05)。结论在非梗阻性无精子症患者和生精正常男性都发现了TEX11外显子2个相同单核苷酸多态性(SNP)(Exon 7:c.389 A>G;Exon 17:c.1351 G>A),本研究推论这2种突变不影响TEX11的功能。     

微创取精术联合卵胞浆内单精子注射术治疗不射精症不育的研究

目的探讨微创取精术获取的精子联合卵胞浆内单精子注射术（ICSI）治疗不射精症患者的临床效果。方法将36例不射精症患者按获取精子的方式不同分为2组。附睾精子组31例,采用经皮附睾精子抽吸术（PESA）;睾丸精子组5例,经PESA术未获得精子而进行睾丸精子获取术（TESE）。2组患者均行ICSI治疗。观察2组受精、卵裂、优质胚胎及临床妊娠等情况。结果 36个例患者共获得MⅡ期卵子403个,其中附睾精子组342个（84.8%）,总受精率为76.3%（261/342）,卵裂率为95.0%（248/261）,优质胚胎率为47.9%（119/248）,获得临床妊娠率为41.9%（13/31）;睾丸精子组获得MⅡ期卵子61个（15.1%）,总受精率为68.8%（42/61）,卵裂率为92.9%（39/42）,优质胚胎率为48.7%（19/39）,获得临床妊娠率为40.0%（2/5）。2组患者的受精率、卵裂率、优质胚胎率及临床妊娠率比较差异均无统计学意义（均P〉0.05）。结论通过微创取精术联合ICSI治疗不射精患者的生育问题是安全有效的。不射精患者的附睾精子和睾丸精子具有相同的受精和获得优质胚胎的能力。     

Hip Labral Reconstruction: Techniques and Outcomes

Purpose of ReviewWith increased understanding of the biomechanical function of the acetabular labrum, more attention has been directed towards surgical techniques that preserve or restore normal joint anatomy. While labral repair has been shown to produce superior outcomes to labral debridement, repair is not always possible in the setting of severe labral intrasubstance tearing or deficiency. These patients were previously left without suitable arthroscopic treatment options.Recent FindingsLabral reconstruction is an emerging procedure that has been shown to offer promising outcomes for traditionally difficult-to-treat hip pathology. Short- and mid-term follow-up studies have consistently demonstrated significant improvement in patient-reported outcomes, function, and patient satisfaction postoperatively, often despite less favorable preoperative characteristics.SummaryLabral reconstruction is a viable arthroscopic treatment option that has been shown to reliably produce clinically meaningful results in patients with severe labral pathology that is not amenable to repair/refixation or augmentation.     

Arthroscopic Transtibial PCL Reconstruction: Surgical Technique and Clinical Outcomes

Purpose of review

Posterior cruciate ligament (PCL) injuries are relatively uncommon injuries. As such, there is a dearth of high-quality studies in the literature examining the operative management of PCL injuries and a lack of clear consensus on what the optimal method should be. The goal of this review was to conduct a comprehensive evaluation of recent literature and provide an evidence-based algorithm to optimize surgical decision-making and outcomes for PCL reconstruction.

Recent findings

Recent literature confirms that transtibial PCL reconstruction is a reliable and reproducible method to manage PCL injuries and results in satisfactory patient outcomes. However, there does not yet appear to be enough new, compelling information to conclusively determine an optimal method for surgical management.

Summary

Our preferred method of management for operative PCL injuries is a single bundle transtibial PCL reconstruction, which is supported by the current body of literature. Future high-quality research studies are necessary to further guide treatment algorithms.

     

无精子症23例分析

无精子症是男性不育症中严重的疾病 ,病因复杂 ,诊断较为困难。睾丸活检同时行精路附睾造影有一定诊断价值。现将我院 2 3例资料完整睾丸活检加精路附睾造影结果分析讨论如下。1　材料与方法1995年 10月～ 1999年 5月共做了 2 3例睾丸活检 ,19例同时双侧精路附睾造影 ,3例因输精管纤细无法穿刺 (均经手术探查证实 )未行造影 ,1例失败。年龄 2 3～ 37岁 ,平均年龄 2 9.2岁 ,婚史 6个月～ 11年 ,平均 3.1年 ,均 3次精液常规检查未找到精子 ( 5例并行性交后尿沉淀检查均未发现精子 ) ,据此诊为无精子症。 2 3例病人经血ＦＳＨ、ＬＨ、ＰＲＬ、…     

Medial Patellofemoral Ligament Reconstruction Techniques and Outcomes: a Scoping Review

Purpose of ReviewThe purpose of this scoping literature review was to summarize the current evidence on techniques and outcomes following MPFL reconstruction including sources of evidence, key concepts, and gaps in the literature.Recent FindingsA thorough electronic database search included studies published from 2016 to April 26, 2021, identified a total of 144 peer reviewed articles. Of the 144 identified clinical papers, 80 (56%) were of level IV evidence, 49 (34%) were of level III evidence, 11 (8%) were level II evidence, and 4 (3%) were level I evidence. Overall, 10,710 patients (11,466 knees) were included with 6871 (64%) female. The mean age of patients included in these studies was 23.5 years (range=5 to 59).SummaryIn recent years, there has been a substantial quantity of evidence published on MPFL reconstruction from a variety of different countries and journals and of variable methodological design. Isolated MPFL reconstruction results in a decrease in patellar height postoperatively. Indications for isolated MPFL reconstruction versus concomitant procedures to address bony morphology is still incompletely defined. When failure does occur after MPFL reconstruction, femoral tunnel malposition is the most commonly cited cause. Despite several recent studies focused on optimal MPFL reconstruction techniques, there is currently no consensus on optimal graft type (most common being hamstring autografts, allografts, and recently synthetic grafts) or femoral fixation strategies, with similar results reported with each technique. Future studies should focus on optimal techniques for each patient population as well as specific indications for additional concomitant realignment procedures.