Palomo和改良Palomo曲张精索内静脉结扎术对大鼠同侧睾丸的影响

目的 评估PMomo曲张精索内静脉结扎术(PV)和改良Palomo曲张精索内静脉结扎术(MPV)对大鼠同侧睾丸的影响.方法 检测实验性左侧精索静脉曲张(ELV)组(9只)、PV组(10只)、MPV组(8只)、和对照组(8只)大鼠左侧睾丸的Johnsen's评分、生精小管的超微结构、和生殖细胞凋亡指数(AJ).结果 对照组Johnsen's评分(9.46±0.52)显著高于ELV组(7.72±0.31,P＜0.05)和PV组(2.86±0.31,P＜0.01),与MPV组(9.42±0.63)比较差异无统计学意义(P＞0.05);对照组AI(2.21±1.15)显著低于ELV组(5.32±1.23,P＜0.05)和PV组(9.26±1.98,P＜0.01),与MPV组(2.32±1.18)比较差异无统计学意义(P＞0.05);ELV和PV组生精小管的超微结构明显异常.结论 MPV可以修复ELV所导致的同侧睾丸的损伤,PV则使损伤进一步加重.     

对比Palomo手术与腹膜后精索内静脉高位结扎术治疗精索静脉曲张

目的对比经腹膜后集束结扎精索血管（Palomo手术）与腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的疗效及并发症。方法对2000年7月-2006年6月间，25例采用Palomo术式，30例采用腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的临床资料进行对比分析。结果所有手术均获得成功，术后随访6月至2年。Palomo手术组手术时间12～18min，手术后3—10d曲张静脉团显著缩小，所有患者临床症状消失。随访18例，无复发，无睾丸坏死或萎缩发生，6个月内发生左侧睾丸鞘膜积液3例，占16．6％，左侧慢性附睾炎1例，左侧睾丸疼痛（排除其它原因）1例。单纯精索内静脉高位结扎组手术时间20-35min，1例术后无效，29例术后1—8d曲张静脉团消失。3例术后2—4月后复发，占15％。精索内静脉高位结扎组术后复发率显著高于Palomo手术组（P〈O．05），而后者术后并发症明显高于前者，两者有显著的统计学差异（P〈0．05），主要并发症是患侧的睾丸鞘膜积液。后者手术时间明显较短（P〈0．01）。两组手术均效果良好，疗效可靠。结论Palomo手术简单易行、疗效可靠，但并发症较多；腹膜后精索内静脉高位结扎复发率高，但无并发症发生。     

腹腔镜精索内静脉结扎术的应用

１９９２年３月～１９９４年１月在新加坡ＴｏａＰａｙｏｈ医院泌尿外科共参加腹腔镜精索内静脉结扎术１１０例，结合本院手术９例共１２８例。年龄２５～４８岁。术前除常规检查外，尚进行多普勒超声听诊器检查精索或彩色多普勒超声显像检查。精索内静脉解剖分离后用钛夹结扎，然后剪断，精索动脉保留，通常有２～４条较粗的精索内静脉需处理。本组病人大多数在术后当天出院，９０％患者一周内即可恢复正常活动，是治疗男性不育症的一种较为理想的手术方法。     

腹腔镜保留动脉和淋巴管的精索内静脉结扎术和Palomo术疗效的对比研究

目的:探讨腹腔镜下保留睾丸动脉和淋巴管的精索内静脉结扎术(Artery-Lymphatics Sparing Laparoscopic Varicocelectomy,ALSLV)和精索高位集束结扎术(Palomo)术临床疗效的优劣性.方法:对2005年9月至2009年5月间,成功接受ALSLV术的52例(57侧)(ALSLV组)及接受Palomo手术的21例(23侧)(Palomo组)并得到随访的精索静脉曲张不育患者的临床资料进行前瞻性对比研究.结果:两组患者术前和本研究相关的特征参数有可比性;ALSLV组平均手术时间明显长于Palomo组(P<0.05);两组的平均住院时间、平均治疗费用、VC复发率无显著性差异(P>0.05);ALSLV组术后精液参数改善率和自然妊娠率显著高于Palomo组,术后睾丸疼痛、睾丸鞘膜积液及睾丸萎缩发生率显著低于Palomo组(P<0.05).结论:本组资料显示ALSLV手术耗时稍长,但其临床疗效显著优于Palomo手术,是一种安全、有效、值得推广的手术方式.     

改良腹膜后精索内静脉结扎术43例

1 临床资料 我科1996-10/2000-04开展改良腹膜后精索内静脉结扎术治疗精索静脉曲张患者43例,年龄18～36岁,左侧精索静脉曲张40例,双侧3例,其中阴囊坠胀感11例。未育15例,体格检查发现而手术17例。临床分期;轻度5例,中度31例,重度10例,全部患者均做彩超检查后证实为原发性精索静脉曲张。距离髂前上棘内2cm为起点,沿     

显微镜下精索内静脉高位结扎术对精索静脉曲张患者精液质量的影响

目的 探讨显微镜下精索内静脉高位结扎术在精索静脉曲张患者治疗中的临床效果。方法 回顾性收集2019年10月至2022年10月期间收治的86例精索静脉曲张患者,根据术中采用的手术方式划分为观察组（显微镜下精索内静脉高位结扎术）43例和对照组（腹腔镜下精索内静脉高位结扎术）43例,比较分析两组数据指标。结果 观察组患者手术时间（103.47±12.42） min较对照组长（82.73±9.81） min,差异显著（P<0.05）;观察组住院时间（4.58±0.75） d较对照组（6.12±0.84） d短,差异有统计学意义（P<0.05）;观察组患者精子浓度（46.41±5.72） 106/mL、精子活动率（67.87±6.94%）和精子存活率（75.73±7.89%）均较对照组明显升高（42.81±5.33） 106/mL、（62.84±6.25）%和（66.43±7.04）%,差异有统计学意义（P<0.05）;观察组患者精液量（4.22±0.58） mL较对照组（3.79±0.47） mL多,差异有统计学意义（P<0.05）;观察组术后发生阴囊水肿1例、鞘膜积液...     

针式腹腔镜精索内静脉结扎术

目的:探讨针式腹腔镜行精索内静脉结扎术的手术方法和效果。方法:行针式腹腔镜精索内静脉结扎术72例,双侧33例,左侧39例,共105侧。采用硬膜外复合静脉麻醉,分别于下腹正中线作2个2 mm切口,1个5mm切口,利用结扎速血管闭合系统凝闭精索内静脉。结果:72例顺利完成手术,平均手术时间单侧15 m in,双侧21 m in,术后住院3~5 d。术后随访6~12个月,未见复发。结论:针式腹腔镜精索内静脉结扎术效果确切,创伤小,恢复快,是治疗原发性精索静脉曲张的较好选择。     

腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术的疗效比较

目的:对比观察腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术治疗精索静脉曲张的优点。方法:将36例腹腔镜下精索血管集束结扎术与38例腹腔镜下单纯精索内静脉结扎术的临床资料进行对比研究。结果:两组病例手术时间与术中出血量有明显差异(P<0.05);术后经12个月随访,两组间术后治愈率及复发率有明显差异(P<0.05)。结论:腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术相比,具有手术时间短、术中出血少、安全且治愈率高等优点。     

腹腔镜双侧精索静脉高位结扎术

目的:探讨腹腔镜双侧精索静脉高位结扎术治疗精索静脉曲张的手术方法与疗效。方法:回顾分析腹腔镜双侧精索静脉高位结扎28例的临床资料。结果:手术均获成功,术中基本无出血,术后肠功能恢复后出院。平均住院1.5d。复查示曲张静脉明显减轻或消失,随访6~12个月,21例不育症精液分析较术前明显改善,18例在术后1年内配偶成功妊娠,无1例复发。结论:应用腹腔镜双侧精索静脉高位结扎有患者创伤小,避免漏扎静脉,手术操作简单,易掌握,不分离血管避免了出血,不造成睾丸萎缩,康复快,成功率高等优点,是值得临床推广的术式。     

腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效观察

目的观察腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效。方法 回顾性分析对精索静脉曲张45例患者采用腹腔镜下精索静脉高位结扎术治疗的临床资料。结果本组患者均顺利完成手术,手术时间30～60 min,平均40 min。术后左阴囊气肿2例,反应性睾丸鞘膜积液1例,阴囊坠胀不适感2例,均未做任何处理,2 d内自行消退。所有患者精索静脉曲张症状均消失或明显改善,无复发和睾丸萎缩。结论腹腔镜精索静脉高位结扎术治疗精索静脉曲张创伤小、复发率低,必将彻底代替传统的开放性手术。     

微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用：附视频

目的 探讨微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用价值.方法 回顾分析2012年1月至2013年1月期间中山大学附属第一医院东院收治的89例精索静脉曲张患者的临床资料.患者均行改良的腹股沟下显微精索静脉结扎术,2012年9月之前术中未应用微型血管多普勒,2012年9月之后术中常规应用微型血管多普勒辨别动脉和静脉.比较两组患者的临床资料.结果 89例患者共138次手术均获成功,术后随访3～6个月,未见睾丸萎缩和鞘膜积液发生.非多普勒组术中有1例精索内动脉被误扎,2例术中精索动静脉辨认不清,术后1例复发;多普勒组术中辨别动脉和静脉准确,无动脉损伤和误扎情况发生,术后无复发.结论 在微型血管多普勒辅助下行显微精索静脉结扎术更安全有效.     

改良外环下显微镜精索静脉结扎术的临床疗效观察

目的 探讨分析改良外环下显微镜精索静脉结扎术对精索静脉曲张的临床疗效.方法 回顾性分析本院2012年8月至2014年6月收治的精索静脉曲张患者112例,按照不同的手术方式分成腹股沟结扎组28例,腹腔镜组28例,腹股沟外环下显微镜组28例,改良外环下显微镜组(外环口纵向切开约1 cm)28例.对比分析各组的手术效果及术后并发症.结果 四组手术均顺利完成.应用显微镜的两组间手术时间无统计学差异(P＞0.05),但比腹股沟结扎组、腹腔镜组手术时间长(P＜0.05).显微镜两组间住院时间无统计学差异(P＞0.05),比腹股沟结扎组、腹腔镜组住院时间明显缩短(P＜0.05).根据术后疼痛(VAS)评分,显微镜的两组术后疼痛较轻(P＜0.05),且这两组组间比较无统计学差异.腹股沟外环下显微镜组与改良外环下显微镜组保留精索动脉数比较统计学有显著差异(P =0.001),改良外环下显微镜组遇到的动脉数更少.四组间术后并发症,显微镜两组较低(P＜0.05),而这两组组间比较无统计学差异(P＞0.05).四组的复发率分别为28.6％、10.7％、0％、0％(P＜0.05),显微镜的两组均无复发.术后四组的精液密度、精液活力都较术前得到改善,其中显微镜的两组改善更明显,这两组组间比较无统计学差异(P＞0.05).1年后自然怀孕率,四组间差异无统计学意义(P＞0.05).结论 显微镜治疗精索静脉曲张疗效好,并发症少,术后疼痛轻及住院时间短.同时改良外环下显微镜精索静脉结扎术更易于操作,是一种安全有效的手术方式.     

The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters

Purpose

We studied the effect of varicocele ligation on Kruger strict morphology criteria and semen parameters in patients with infertility.

Materials and Methods

A total of 90 patients diagnosed with varicoceles and a normal morphological sperm ratio of less than 14% were evaluated before and 6 months after varicocelectomy. Preoperatively and postoperatively sperm density, motility and morphology using Kruger strict criteria were analyzed. The Wilcoxon test was used to measure levels of statistical significance in all analyses.

Results

Significant improvement in sperm concentration and motility was evident after varicocele ligation (p <0.0002 and <0.0001, respectively). Using the Kruger classification sperm morphology evaluation revealed a significant increase in the percent of normal forms, and of forms with head and acrosome defects (p <0.0001, <0.0014 and <0.0028, respectively). There were no concomitant changes in strict morphology in forms with mid piece and tail defects or immature forms (p >0.05). Of the 90 patients 18 (20%) achieved a successful full-term pregnancy, including 14 via natural cycle intercourse and 4 by intrauterine insemination.

Conclusions

Surgical correction of varicocele was associated with significant improvement in density, motility and sperm morphology evaluated using the Kruger classification.     

Ultrastructural effects of cadmium on the rat epididymis

The short-term effect of a subcutaneous injection of 3 μmol of cadmium chloride/100 g body weight were examined 90 min later in male rats. The main target of cadmium, as shown by electron microscopy, was the endothelial lining of capillaries of the caput epididymidis. Intercellular junctions between endothelial cells were disorganized, ranging from slight separation between cytoplasmic leaflets to wide gaps which communicated freely with the pericapillary tissue. Disruption of platelets and intravascular clotting followed these early endothelial lesions, and clotting was found in venules as an extension of clotting from the capillaries. Pre-treatment with zinc (300 μmol zinc chloride/100 g body weight) prevented all of the lesions described above.     

Effect of piperine on the epididymis of adult male rats

Aim： To study the effect of piperine on the epididymal antioxidant system of adult male rats. Methods： Adult male rats were orally administered piperine at doses of 1 mg/kg, 10 mg/kg and 100 mg/kg body weight each day for 30 consecutive days. Twenty-four hours after the last treatment, the rats were weighed and killed with ether and the epididymis was dissected from the bodies. Sperm collected from the cauda region of the epididymis was used for the assessment of its count, motility and viability. Caput, corpus and cauda regions of the epididymis were separated and homogenized separately to obtain 10 % homogenates. The supernatants were used for the assays of sialic acid, superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, lipid peroxidation and hydrogen peroxide generation. Results： Body weight of the piperine-treated rats remained unchanged. The weights of the caput, corpus and cauda regions of the epididymis significantly decreased at dose of 100 mg/kg. Epididymal sperm count and motility decreased at 10 mg/kg and 100 mg/kg, and sperm viability decreased significantly at 100 mg/kg. Sialic acid levels in the epididymis decreased significantly at 100 mg/kg while significant decrease in the cauda region alone was observed at 10 mg/kg. A significant decline in the activities of superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase, along with an increase in hydrogen peroxide generation and lipid peroxidation were observed at 10 mg/kg and 100 mg/kg. Conclusion： Piperine caused a decrease in the activity of antioxidant enzymes and sialic acid levels in the epididymis and thereby increased reactive oxygen species levels that could damage the epididymal environment and sperm function.     

Impact of foetal-onset hypothyroidism on the epididymis of mature rats

It is well established that congenital hypothyroidism leads to male infertility. However, there is a dearth of information on foetal-onset hypothyroidism-induced changes in the epididymis. With regard to transient hypothyroidism, the existing literature deals mainly with the testis. However, it is not known whether there is any corresponding alteration in epididymal morphology and physiology under such a condition. The present study is therefore aimed at understanding the impact of persistent and transient hypothyroidism on the concentration of epididymal sex steroids, as they play a vital role in maintaining the normal structure and function of the epididymis. Normal rats of 90 days of age served as controls (Group I). Hypothyroidism was induced by using pregnant/lactating mothers and post-weaning rats to 0.05% (w/v) methimazole (MMI) in the drinking water. Group II were subjected to persistent hypothyroidism from day 9 of post-coitum (pc) to 90 days. Group III rats were subjected to transient hypothyroidism from day 9 day pc to day 1 post-partum (pp), 21 pp or 35 pp (IIIa, b and c, respectively) and group IV rats were given simultaneous T3 supplementation (3 microg/100 g body wt./day i.m.) with MMI from day 9 pc to day 1 pp; 21 pp and 35 pp (Group IVa, b and c). Animals from all groups were killed on day 90 pp. Serum thyroid stimulating hormone (TSH) and thyroid hormones confirmed euthyroidism in group I, IIIa, b and c and IVa, b and c rats and hypothyroidism in group II rats. Caput and cauda epididymal concentration of testosterone, dihydrotestosterone (DHT), estradiol (E2) and androgen binding protein (ABP) markedly decreased in group II rats. While the concentration of testosterone, E2 and ABP increased in group III rats, that of DHT remained unaltered. However, group IV rats maintained normal concentration of the sex steroid and ABP. The activity of 5-alpha-reductase in the epididymis of all the groups followed the same trend as that of the concentration of epididymal DHT. From the present data it is evident that persistent hypothyroidism diminishes the bioavailability of androgens and oestrogens, while transient hypothyroidism enhances the same, indicating the importance of euthyroidism during foetal and neonatal period towards the maintenance of optimal hormonal status in the epididymis required for its maturation.