输精管结扎干扰前列腺增生过程的机制探讨——精浆睾酮双氢睾酮的放射免疫测定

本文应用放射免疫测定的方法检测了13例输精管结扎后(平均15.3年,平均年龄50岁)的男性精浆双氢睾酮和睾酮的浓度,另取同年龄组男性13例作为对照。结果表明,精浆睾酮在结扎组(374.54p/ml)和正常对照组(315.64Pg/ml)中没有明显差异,而结扎组精浆中双氢睾酮(46.21pg/ml)却明显低子对照组(184.27pg/ml(p<0.01)。作者认为,输精管结扎对精浆DHT有长期影响,这可能是其对前列腺增生过程产生抑制作用的原因之一。     

广东省输精管绝育技术应用状况调查

为分析影响输精管结扎术推广应用技术因素,了解基层手术点的手术质量,1994年～1995年对23个基层手术点作现场调查,发现影响男性结扎手术质量的一些因素,例如部分基层手术点操作不规范,未能按《节育手术常规》操作,手术管理制度不够严格。建议:①加强男性结扎术操作规范化的培训。②推广新型的手术消毒剂和先进的操作方法。③重视心理咨询和心理护理。④强调节育效果是手术质量的主要指际。⑤完善手术管理制度。     

家犬实验性附睾淤积症及其超声波治疗对附睾起始部超微结构的影响

实验性附睾淤积症引起家犬附睾起始部主细胞超微结构异常改变,但较附睾体部所见为轻;经超声波处理后(功率0.75W/cm~2,每日一次,每次8min,连续7日)则见其明显改变、或完全恢复,且未造成附睾起始部主细胞新的损伤。本实验结果在与附睾体部主细胞相应变化进行比较后,发现由于附睾淤积症对附睾管不同部位的影响是不同的,因而这种形态和功能均已不同程度改变了的附睾不同部位的主细胞对超声波作用的反应也各不相同,这除因主细胞功能状态不同外,尚与超声波声场的不均匀有关,提示探寻超声波治疗最适宜的量不仅必要,而且是有可能找到的。     

输精管结扎兔睾丸IL-1与血浆睾酮变化的研究

为了探讨输精管结扎术后睾丸IL—1的活性、来源及其与睾酮变化的关系,同步检测了结扎6、25个月家兔辜丸匀浆上清IL—1活性和血浆睾酮含量,并进行了睾丸组织IL—lmRNA的原位杂交.结果表明:(1)睾丸组织匀浆上清IL-1活性以VG6为高,与SOG6比较有显著差异(P<0.01);(2)睾丸组织IL-1mRNA的原位杂交,VG6中IL-lmRNA的杂交信号明显强于其他各组,杂交信号主要分布在曲细精管内的 Sertoli细胞和生殖细胞,也见于间质中的某些细胞中;(3)血浆睾酮含量结扎术后6个月明显降低,与对照组比有显著差异(P<0.05),IL-1活性与血浆睾酮含量呈明显的负相关关系(r=-0.595,P<0.01).故推测,结扎早期睾丸炎症所引起的巨噬细胞活化和Sertoli细胞吞噬变性精子和残余体过程增强,可能是睾丸IL-1的主要来源.输精管结扎术后IL-1活性的一过性升高可能是睾酮含量下降的原因.IL-1可能作为旁分泌调节因子抑制Leydig细胞睾酮合成.     

Do mobile family planning clinics facilitate vasectomy use in Nepal?

Background

Nepal has a distinct topography that makes reproductive health and family planning services difficult to access, particularly in remote mountain and hill regions where over a quarter of modern contraceptive users rely exclusively on vasectomy.

Study design

A three-level random intercept logistic regression analysis was applied on data from the 2011 Nepal Demographic and Health Survey to investigate the extent of influence of mobile family planning clinics on the odds of a male or a female sterilization, adjusting for relevant characteristics including ecological differences and random effects. The analyses included a sample of 2014 sterilization users, considering responses from currently married women of reproductive ages.

Results

The odds of a male sterilization were significantly higher in a mobile clinic than those in a government hospital (odds ratio, 1.65; 95% confidence interval, 1.21–2.25). The effects remained unaltered and statistically significant after adjusting for sociodemographic and clustering effects. Random effects were highly significant, which suggest the extent of heterogeneity in vasectomy use at the community and district levels. The odds of vasectomy use in mobile clinics were significantly higher among couples residing in hill and mountain regions and among those with three or more sons or those with only daughters.

Conclusion

Mobile clinics significantly increase the uptake of vasectomy in hard-to-reach areas of Nepal. Reproductive health interventions should consider mobile clinics as an effective strategy to improve access to male-based modern methods and enhance gender equity in family planning.

Implications

Family planning interventions in hard-to-reach communities could consider mobile clinic as an effective strategy to promote male-based modern methods. Improving access to vasectomy could substantially reduce unmet need for family planning in countries experiencing rapid fertility transition.     

输精管结扎术后附睾瘀积—发生机制及其防治方法的研究

木文对输精管结扎后的“附睾瘀积”进行了系统研究。选用金黄地鼠为实验动物，结扎组８４只，对照组７６只。采用微穿刺、微量分析方法证实扎管后附睾功能受损。组织学检查示附睾管扩张，间质充血，有大量慢性炎细胞浸润。临床收集４９例病人，３９例微波治疗，１０例手术，效果优良。采用Ｂ超、Ｃ超、ＭＲＩ观察瘀积附睾，发现附睾瘀积多位于附睾尾部。人类标本的光镜及电镜检查证实，附睾瘀积的病理实质是附睾对外渗精子的一种无菌性炎症反应。本文根据研究资料，阐明了附睾瘀积的发生机制，提出了防治方法，并定名为“附睾瘀积综合征”。     

家兔输精管结扎16月睾丸功能变化及其机制的实验研究

18只日本大耳白雄兔随机分为输精管结扎组(VG)和假手术组(SOG)。术后第16月进行睾丸功能与形态学观察。结果表明:血清睾酮含量两组无明显差异(p>0.05);睾丸环-磷酸腺苷cAMP含量与血管紧张素Ⅰ转换酶(ACE)活力,Na~+,K~+-ATP酶及Mg~(++)-ATP酶比活性呈显著的正相关,两组比较,VG的cAMP含量与酶活力均明显地低于SOG;输精管结扎术后自身免疫性睾丸炎可能是睾丸生精功能抑制的重要原因。     

输精管结扎与吻合后人精浆L－肉毒碱果糖含量及α－1、4糖苷酶活力研究

本文报道了６３例接受显微外科输精管吻合术患者术前和４８例术后１～１２个月精浆α－１、４糖苷酶活力，Ｌ－肉毒碱和果糖含量的结果，并以４７例正常生育男子作对照研究。输精管结扎后男子精浆α－１、４糖苷酶活力与Ｌ－肉毒碱合量明显低于对照组。在吻合术后随访期间，约２／３男子输精管复通良好，精子密度（　），精浆α－１、４糖苷酶活力（４２．３６±３１ｍＩＵ／ｍｌ）和Ｌ－肉毒碱含量（４７１．８５±１９４．７１ｎｍｏｌ／ｍｌ）均达正常水平。１／３男子精浆α－１、４糖苷酶活力、Ｌ－肉毒碱含量无明显增高，同时表现出少精子（５．３±４．２×１０６／ｍｌ）与无精子。