应用中国商环包皮环切手术标准化方案对328例成年男性包皮环切的临床报告

目的:成年男性包皮环切手术标准化和培训可显著降低因手术引起的并发症发生率。由于目前国内外尚无可供参考的成年男性包皮环切手术标准化方案和培训制度,使得临床医生开展成年男性包皮环切手术的质量无法保证。为了建立成年男性包皮环切手术标准化和培训制度,便于临床医生和相关医护人员学习和掌握包皮环切器的临床应用技巧,以中国商环(简称"商环,ShangRing")包皮环切技术为例,根据商环的技术特点和临床实践经验,特别制订了商环包皮环切手术标准化方案,并将其标准化操作运用于临床。方法:采用商环包皮环切手术标准化方案对328例受术者(年龄18～58岁,平均27.8岁;已婚134例,未婚194例;包茎25例,包皮过长303例)进行包皮环切手术。对手术时间、疼痛评分(视觉模拟评分法,VAS)、术后并发症、包皮创口愈合时间、术后外观满意情况进行观察和随访。结果:手术时间为(4.70±1.31)min。手术时受术者疼痛(VAS)评分为(0.24±0.59)分,术后24h疼痛评分为(1.59±0.95)分,去环前24h内疼痛评分(1.72±1.11)分,去环时疼痛评分为(2.72±1.37)分。主要并发症发生率为术后感染0.6%(2/328)、出血0.6%(2/328)、伤口裂开0.6%(2/328)和水肿4.89%(16/328)。在发生出血和伤口裂开的受术者中无1例需要缝合。术后包皮创口完全愈合时间为(20.30±6.69)d。受术者对术后外观满意率99.7%(327/328)。结论:商环包皮环切术具有手术方式易于标准化、手术时间短、术中疼痛轻、术后无须特殊护理、容易完整保留系带,并完全暴露冠状沟、术后外观满意度高、受术者易于接受等优点。初步证明了中国商环包皮环切手术标准化方案的可接受性,严格按照此方案实施手术和随访护理,能最大化地实现商环包皮环切技术的诸多临床优势,将并发症发生率控制在可接受的范围内。

中国商环(Shang Ring)男性包皮环切技术临床应用研究进展

男性包皮环切能显著降低男性阴茎-阴道性交获得性HIV感染风险大约60%,被WHO和联合国艾滋病规划署(UNAIDS)推荐作为HIV预防策略中的一个重要干预措施。寻求一种更加安全、有效和可接受的男性包皮环切器械和手术方法,以便能够满足加快执行扩大包皮环切预防HIV感染项目的需求,已经成为相关国际组织,特别是非洲国家政府公共卫生事业的当务之急。2008年中国商环(Shang Ring)包皮环切标准化手术方案的建立,以及应用这个标准化手术方案和手术培训在中国以及2009年和2010年在肯尼亚实施中国商环成人包皮环切手术获得有用的和有意义的临床数据,证明了中国商环包皮环切术的诸多优势。手术培训手册和教学视频的多次修订为培训医护人员提供了更加准确的教学指南。经过多家相关国际机构专家的考察和评估,中国商环包皮环切技术已经成为支持在非洲HIV高发地区扩大包皮环切服务预防HIV感染项目最具潜力的候选包皮环切器械之一。可以预计,中国商环包皮环切技术的成功应用将会在改变数百万非洲人的生活方式的同时,也为中国男科学与泌尿外科学医生在包皮环切与HIV预防和生殖健康相关的临床研究领域提供了丰富的机会。本文报告了2008年2月至2010年底期间中国商环包皮环切技术临床应用的国际和国内研究进展。

推广男性包皮环切术对降低生殖道感染促进生殖健康的意义

男性包皮环切能显著降低60%男性阴茎-阴道性交获得性HIV感染风险,被WHO和联合国艾滋病规划署推荐为HIV预防策略中的一个重要干预措施。越来越多的研究已经证实,男性包皮环切也能降低人乳头瘤病毒、单纯疱疹病毒2型和其他性传播疾病感染风险,降低前列腺癌风险,为男女性生殖健康提供长远的益处。然而,男性包皮环切对促进两性生殖健康的长远益处与可接受性在中国一直被低估。最近累积的研究证据提示,男性包皮环切术,特别是应用创新的男性包皮环切术,例如中国商环将在HIV预防和促进人类生殖健康中发挥十分重要的作用,本文即对上述问题进行阐述。

中国的男性包皮环切术与艾滋病预防

2008年2月25日，中华医学会男科学分会主任委员朱积川教授带领男科学分会候任主任委员王晓峰教授、副主任委员黄宇烽教授、黄翼然教授、姜辉教授、邓春华教授，《中华男科学杂志》编辑部主任商学军副教授，

3种精子计数池的质量评估

目的 :精液分析仍然是评估男性生育能力的一项重要的实验测试。然而 ,较少严格的医院男科学实验室精液分析质控使得比较不同实验室 ,甚至同一实验室在不同时间之间的精液分析结果变得非常困难或毫无意义。本文的目的是评价男科学实验室常用的血球计数池、Makler计数池及Cell VU计数池的准确性 ,为建立标准化的精液分析方法提供科学的实验依据。 方法 :以含已知浓度的 (HamiltonThorneBiosciences,USA)美国男科学实验室质控 (USandrologylabQC)乳胶珠溶液为QC标准溶液 ,分别用 3种计数池计数 ,并进行比较和分析。 结果 :Cell VU、血球计数池及Makler计数池计数的乳胶珠浓度分别为 (37.6 3± 4 .89)、(4 2 .74± 4 .98)、(5 3.5 2± 6 .6 7)×10 6/ml和 (18.2 2± 1.77)、(2 0 .4 8± 1.5 6 )、(2 4 .97± 4 .75 )× 10 6/ml,相应的两种标准溶液的浓度分别为 (35± 5 )和(18± 2 .5 )× 10 6/ml。Cell VU计数池的平均乳胶珠浓度类似于标准溶液 ,而血球计数池及Makler计数池的平均乳胶珠浓度显著高于Cell VU计数池 (P <0 .0 0 1)。与标准乳胶珠浓度相比 ,Cell VU计数池的平均变异系数 (CV)为7.5 1%和 1.2 2 % ,而血球计数池和Makler计数池的CV分别为 2 2 .11%、13.78%和 5 2 .91%、38.72 %。 结论 :不?

梗阻性无精子症显微外科治疗进展和展望

近年来,随着辅助生殖技术,尤其是男性不育显微外科技术的迅猛发展,部分过去无法自然生育的梗阻性无精子症患者可重建精道,进而获得自然妊娠的机会。本文着重介绍梗阻性无精子症的精道重建手术的最新进展,包括腹腔镜技术、机器人技术等新技术在重建精道方面的具体应用;同时分析了显微外科附睾精子抽吸术及精子保存、可吸收缝线显微外科吻合技术和生物缝合带包裹输精管吻合口的显微外科输精管吻合术在梗阻性无精子症中的应用前景等。

男性包皮环切是艾滋病预防和生殖健康的一种“外科疫苗”

近些年来,多项大规模随机对照临床试验证明,成年男性包皮环切能有效减少艾滋病毒(HIV)、人乳头瘤病毒(HPV)和2型单纯疱疹病毒(HSV-2)的性传播。世界卫生组织(WHO)和联合国艾滋病规划署(UNAIDS)发表了一系列关于推广男性包皮环切的文件。男性包皮环切是花费少,效益高,十分安全的小手术,一生中只要做一次。它不仅仅在预防艾滋病等性传播疾病方面有效,而且在预防婴幼儿和老年人的尿路感染,预防生殖系统肿瘤以及改善生殖器卫生等方面也很有效。因此,男性包皮环切被认为是一种艾滋病预防和生殖健康的"外科疫苗"。与全球约30%男性包皮环切率相比,我国的包皮环切率很低(<5%)。本文呼吁政府和医疗界领导和有关专业人士重视国际上已有成功经验,推动我国男性包皮环切的普及,提高我国国民的生殖健康水平。为此,我们再一次提出了有关推广男性包皮环切的六条建议。

中国建立男性包皮环切手术标准化和培训的重要性

尽管HIV在非洲的大流行仍然是一个严重的问题,而在其他地区,如亚洲和南美洲,HIV感染率也正在迅速上升。国际健康组织已经认识到有必要制定有效的策略来检测和控制全球HIV的传播。研究表明,男性包皮环切能显著降低HIV、人乳头状瘤病毒(HPV)、单纯疱疹病毒2型(HSV-2)和其他性传播疾病(STD)的感染率。虽然男性包皮环切技术有许多,但是没有标准化的手术方案和培训计划。研究表明,男性包皮环切技术的标准化与培训计划的实施可以大大降低并发症发生率。并发症发生率高是实施男性包皮环切服务的一个主要障碍。我们建议,在推广男性包皮环切之前应建立手术标准和培训计划。

军队男性包皮环切的历史回顾与展望

成人包皮环切可以预防大多数生殖道感染,显著降低男性获得性HPV、HSV和HIV的感染风险。有关男性包皮环切对军队服役人员健康益处的报道很少。前线的士兵不能保持阴囊与包皮足够的局部卫生条件,容易受到感染,影响执行任务和作战,辅助治疗也会直接给军队增加开支。在服役期间和在派遣之前进行包皮环切可以节省大量时间和成本,对改善官兵生殖健康状况起到长效的益处。这些研究发现正在受到非洲各国军队卫生部门的重视,将成为未来军队卫生和服务的发展方向。在HIV流行可能恶化的亚洲,在军队倡导男性包皮环切术预防生殖道感染和性传播疾病,对提高战斗力和降低医疗成本,增进全社会公众健康状况与国民经济将具有十分显著的战略意义。

外科取精术:选择哪种方法?

在过去的 5～ 10年里 ,医学领域中很少有像生殖医学那样发展迅速 ,特别是使用卵胞浆内精子注射 (ICSI)技术治疗男性不育及先进的外科附睾和睾丸取精术。这两项重大技术进步彻底改变了原先不可治愈的睾丸衰竭 (非梗阻性无精子症 )、射精障碍或不可修复的梗阻性无精子症。那些患有非常严重的不能用特殊方法和手术治疗的不育男性 ,现在有机会利用他们仅有的几条精子做起其生物学子女的父亲。讨论了辅助生育的各种先进的精子取出术 ,重点讨论技术和安全性。每一技术有其特殊的医学适应证。

Effect of follicle-stimulating hormone on sperm quality and pregnancy rate

Aim: To evaluate the possible links between ultrastructural sperm quality and the clinical pregnancy rate in infertile males treated with FSH before intracytoplasmic sperm injection (ICSI). Methods: Forty-four infertile males with idiopathic oligo-asthenozoospermia were randomly allocated to the treated (n=24) and non-treated (control, n=20) groups. Semen analysis was carried out by light and transmission electron microscopy (TEM) before and 12 weeks after FSH therapy. ICSI was performed in all couples. Results: TEM revealed a significant improvement in sperm quality after FSH treatment, particularly in men with their partners achieving clinical pregnancy. The preg nancy rate was 33 % in the treated group and 20 % in the control. Conclusion: Results highlight a positive role of FSH therapy in infertile males before ICSI, which was correlated vvith an increased pregnancy rate in treated couples. We believe that improved sperm ultrastructure after FSH therapy could positively influence the quality and early stage of embryo development, thereby increasing the probability of embryo implantation.

显微外科技术治疗梗阻性无精子症的新进展

显微外科技术在最近 5～ 10年的生殖医学发展中扮演了重要角色。显微外科的睾丸取精技术和附睾取精技术 ,与体外受精和卵细胞内单精子注射技术的结合 ,使得过去一直被认为是难以治疗的因生精功能障碍所致的非梗阻性无精子症的治疗成为现实。与此同时 ,显微外科输精管吻合和输精管附睾吻合的技术革命使治疗梗阻性无精子症的效果显著地改善 ,成为治疗梗阻性无精子症的首选方法。本文着重介绍了显微外科输精管吻合术、输精管附睾吻合术、手术指征与手术成功的要素 ,预测了未来的发展方向 ,讨论了显微外科技术的优势 ,强调了显微外科培训对泌尿外科医生治疗男性不育患者的重要意义。

Male infertility microsurgical training

Microsurgical training is imperative for urologists and clinical andrologists specializing in male infertility. Success in male infertility microsurgery is heavily dependent on the surgeon＇s microsurgical skills. Laboratory-based practice to enhance microsurgical skills improves the surgeon＇s confidence, and reduces stress and operating time, benefiting both the patient and the surgeon. This review provides guidelines for setting up a microsurgical laboratory to develop and enhance microsurgical skills using synthetic and animal models. The role of emerginE techniaues, such as robotic-assisted microsureerv, is also discussed.

精液分析和精子功能测试

Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization （WHO） manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external qualitY control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.

男性不育的遗传学评估

无精子症或严重少精子症男性(<5×10 6/ml)在接受治疗之前应通过遗传学检测确定其不育的真正原因。正确区分梗阻性无精子症(obstructive azoospermia,OA)与非梗阻性无精子症(non-obstructive azoospermia,NOA)至关重要,因为相比于NOA(睾丸体积小、质地柔软、FSH水平升高),OA(正常的睾丸功能、睾丸体积以及FSH水平)的遗传学检测有所不同。在NOA患者人群中,病史回顾、体格检查和实验室检测对于遗传学检测方法的选择是必须的,尤其针对原发性睾丸衰竭或先天性低促性腺激素型性腺功能低下症的NOA患者。遗传学检测包括由于先天性输精管缺如所致OA的囊性纤维化跨膜传导调节因子的检测,和针对严重少精子症或NOA患者的染色体核型分析、Y染色体微缺失等其他特殊检测方法。这些遗传学检测能够帮助判定哪些患者适合药物和/或手术治疗。最新的遗传学分析技术将有助于男性不育的诊断和掌控。

Assessment of released acrosin activity as a measurement of the sperm acrosome reaction

Aim： To develop a method for assessing sperm function by measuring released acrosin activity during the acrosome reaction （AR）. Methods： Human semen samples were obtained from 24 healthy donors with proven fertility after 3-7 days of sexual abstinence. After collection, samples were liquefied for 30 min at room temperature. Standard semen parameters were evaluated according to World Health Organization （WHO） criteria. Calcium ionophore A23187 and progesterone （P4） were used to stimulate the sperm to undergo AR. After treatment, sperm were incubated with the supravital dye Hoechst33258, fixed in a glutaraldehyde-phosphate-buffered saline solution, and the acrosomal status was determined by fluorescence microscopy with fluorescein isothiocyanate-labeled Pisum sativum agglutinin （FITC-PSA）. The percentage of sperm undergoing AR （AR%） was compared to sperm acrosin activities as assessed by spectrocolorimetry. The correlation between AR% and acrosin activity was determined by statistical analysis. Results： The AR% and released acrosin activity were both markedly increased with A23187 and P4 stimulation. Sperm motility and viability were significantly higher after stimulation with P4 versus stimulation with A23187 （P 〈 0.001）. There was a significant positive correlation between released acrosin activity and AR% determined by FITC-PSA staining （r= 0.916, P 〈 0.001）. Conclusion： Spectrocolorimetric measurement of released acrosin activity might serve as a reasonable alternative method to evaluate AR. （Asian J Androl 2008 Mar, 10： 236-242）

Lycopene and male infertility： do we know enough？

There has been a recent renewed interest in the medical treatment of male subfertility. Akhough, intracytoplasmic sperm injection can surmount many of the reproductive challenges imposed upon couples struggling with male infertility, it remains an invasive and expensive treatment modality.

Oocyte Transfer as an Analytical Tool:Vintage Experiments in Domestic Farm Animals

Four transplant studies are described that focus on fertilisation and early development or the progression of unfertilised oocytes （eggs） in the oviduct. （1） Pig eggs transplanted from ovulations induced during the luteal phase of the estrous cycle were fertilised in the oviducts of inseminated recipient animals in estrus. By contrast, pig eggs from donors in estrus became highly polyspermic when transplanted to the oviducts of animals force-mated during the luteal phase. （2） Pig embryos at the stage of hatched blastocysts （ days 7 and 8） could be transplanted successfuUy to synchronous recipients and full embryonic development demonstrated to between days 19 and 23 of pregnancy. Thus, the exposed trophectoderm of developing embryos could withstand the physical ma- nipulation of recovery and transplantation, and the li-fespan of corpora lutea in the unmated recipients could be prolonged by transfer of day 7 and 8 blastocysts. （3） Bovine oocytes aspirated from 2 to 6 mm diameter Graafian follicles and matured in vitro were fertilized normally in the oviducts of inseminated recipient heifers, demonstrating the potential of slaughterhouse ovaries for the generation of embryos. （4） Transplanting equine eggs to a pig oviduct, in which egg descent to the uterus requires only 46 to 48 h, did not reveal a retarded progress of degenerating unferfil- ised horse eggs, suggesting the involvement of nonphysical factors in equine embryo progression to the uterus. Prostaglandins of embryonic origin are now known to be a key. A final section examines the postovulatory role of ovarian follicular cells on the secretory activity of the oviductal epithelium.

Effects of short gamete co-incubation in human in vitro fertilization

Traditionally oocytes have been exposed to sperm overnight for 16-20 h.This long period of co-incubation, however,has been shown to create problems with high levels of reactive oxygen species(ROS),which may affect embryo viability and cause hardening of the zona pellucida.Recently,several positive and negative effects of reducing the co-incubation time to 90-120 min were reported.The objective of this review was to discuss whether short exposure of oocytes to sperm in vitro might affect the clinical results and several problems arose in short gamete co-incubation.