目的:探讨输精管道梗阻性无精子症(OA)的诊疗策略.方法:40例输精管道OA患者为研究对象.首先行输精管道探查,根据术中探查情况行输精管-输精管显微吻合术(W)、输精管-附睾显微吻合术(VE)、交叉输精管-输精管吻合术、交叉输精管-附睾管显微吻合术或睾丸取精冻存术.结果:精道探查后,共行吻合手术26例,取精+冻精手术14例.40例患者中,共有3例患者失访(2例吻合患者,1例冻精患者).随访到的24例吻合术患者术后复通率为58.3％(14/24),自然受孕率为29.1％(7/24).随访到的13例取精+冻精患者中已有11例行ICSI/冻精助孕.结论:输精管道OA,可根据术前严格评估和术中探查行显微复通手术或取精术;复通术后可获得自然妊娠的机会,交叉显微吻合为输精管道复通的有效途径之一.

Objective To evaluate the sperm retrieval rate (SRR) in non-obstructive azoospermia (NOA) associated with cryptorchidism and the effect of age at orchidopexy on SRR.Methods A total of 33 NOA after cryptorchidism (inguinal) and 46 NOA without cryptorchidism (as control) matched for testicular volume,follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels.The NOA after cryptorchidism underwent microdissection of testicular sperm extraction (MD-TESE) from September 2012 to March 2014.The SRR and testicular histology between the two groups were compared.The effect of age at orchidopexy (Group A:age 10 and younger; Group B:age older than 10) on testicular volume,hormone levels (FSH and LH) and SRR were analyzed.Results The SRR in NOA after cryptorchidism (70％,23/33) was significantly higher than that in control group (46％,21/46) (P＜0.05).The histology in NOA after cryptorchidism was significantly better than that in control (maturation arrest:64％ versus 39％ ; Sertoli cell-only syndrome:21％ versus 52％) (P＜0.05).No significant differences were found in testicular volume [(8.51±2.73) mlversus (8.80±5.74) ml],FSH [(24.83±7.63) U/Lversus (25.32±5.66) U/L],LH [(9.19±3.49) U/L versus (10.64±5.67) U/L] and SRR [73％ (11/15) versus 67％ (12/18)] between Group A and Group B (P＞0.05).Conclusions The SRR is significantly higher in NOA after cryptorchidism than that in NOA without cryptorchidism,and it might be the result of better histology in NOA associated with cryptorchidism.The age at orchidopexy shows no correlations with testicular volume,hormone levels and SRR in NOA after cryptorchidism.

BACKGROUND: N-trimethyl chitosan as a transdermal enhancer can affect the permeability of oral drugs through the intestinal mucosa. OBJECTIVE: To investigate the modulation effects of N-trimethyl chitosan chloride on the permeability of etoposide across different intestinal membranes. METHODS: The permeability of etoposide via rat intestinal membranes was evaluated by an in vitro diffusion chamber system after the membranes were isolated from the intestine in rats with or without the co-administration of 10% N-trimethyl chitosan chloride. The concentration of etoposide in the receptor was determined by the high performance liquid chromatography. RESULTS AND CONCLUSION: With co-administration of N-trimethyl chitosan chloride at a low concentration, the absorptive directed transport of etoposide was significantly increased while its secretory directed transport was decreased. It might be possible to improve the absorption of P-glycoprotein mediated drugs by co-administration of N-trimethyl chitosan chloride at a low concentration, therefore to improve the oral bioavailability of these drugs.