Objective:To explore the clinical treatment and postoperative nursing experiences of penile urethral cavernous shunt and tunneling for low-flow priapism greater than 48 hours.Methods:Five patients with low-flow priapism longer than 48 hours underwent penile urethral cavernous shunt and tunneling after surgical contraindications were excluded. Postoperative medical care was closely coordinated through anticoagulation, antiandrogen and based on the theory of empowerment education Milk technology-encourage patients and their families to participate in disease management, using Milk technology to promote penile blood circulation, regularly assess the erection hardness of the penis, perform perioperative care, and try to restore penile cavernous arterial blood flow.Results:The operations were successfully completed. After treatment, the penis of the 5 patients was gradually weakened and the pain was relieved. They were discharged smoothly within 3 days of hospitalization, and all the abnormal erections were eliminated within 1 month after discharge. Follow-up for 6 to 12 months, 1 case was able to maintain Grade 3 erectile hardness and could complete sexual intercourse. One patient maintained Grade 2 erectile hardness. Three patients could only maintain Grade 1 erectile hardness and could not complete sexual intercourse.Conclusion:Penile urethral cavernous shunt and tunneling is safe and effective to treat low-flow priapism longer than 48 hours. Milk technology provides a new way to promote the recovery of blood circulation after penile surgery, which is worthy of further clinical promotion. These 5 patients with priapism have a long course of priapism, and the proportion of sexual function recovery is not high. The treatment of sexual function recovery needs further study.

目的 探讨以睾丸占位为表现的无精子症的鉴别诊断与治疗经验.方法 报告2例以睾丸占位为表现的无精子症,通过阴囊彩超、CT、磁共振成像、内分泌激素、基因检测等检查明确诊断.结果 一例睾丸占位诊断为睾丸肾上腺残余瘤,使用糖皮质激素治疗,患者术后一年复查精液基本恢复正常,睾丸结节较前缩小.另一例睾丸占位诊断为睾丸间质细胞瘤,行睾丸切除术,患者术后4个月复查性激素恢复正常,术后5个月配偶自然怀孕,检查精液示精子数量恢复正常,但1个月后胎儿停止发育,未见睾丸肿瘤复发.结论 以睾丸占位为表现的无精子症病因多样,不同的病因其治疗方法完全不一样,正确的鉴别诊断是治疗的关键.

先天性巨结肠(hirschsprung's disease,HSCR)又称肠管无神经节细胞症,是一种婴幼儿常见的消化道梗阻疾病,发病率为1/5000,男女比例为4:1[1].主要病因是在胚胎发育的5～12周,神经嵴细胞在迁移过程中受阻,导致结肠远端神经节细胞缺失,引起持续性痉挛,近端肠管扩张.临床表现为腹胀、呕吐及排便障碍等 [2].本文报告一例HSCR术后逆行射精患者,病因主要考虑为HSCR手术的副损伤.

目的 探讨门诊小儿包皮环切术围术期医护联合精细化管理措施,以减轻患儿术中和术后疼痛程度,加快患儿术后恢复.方法 选择2019年7月—2020年1月医院泌尿外科门诊收治包皮过长或包茎患儿226例,于门诊手术室行一次性包皮吻合器包皮环切术,按照组间资料均衡可比的原则将患儿分为对照组及观察组,各113例.对照组给予常规管理,观察组给予医护联合精细化管理.评估患儿术中循环指标和术中、术后疼痛程度,手术时间,随访患儿术后5 d内切口感染、包皮水肿、血肿等并发症的发生率.结果 观察组患儿的术中及术后1 h、24 h、72 h疼痛程度评分低于对照组,术中心率和收缩压、并发症发生率均低于对照组,手术时间短于对照组,组间比较差异均有统计学意义(P<0.05).结论 通过应用联合麻醉、术中视听干预、术后联合止痛及术后简化换药程序等围术期精细化管理方法,能有效减轻患儿术中和术后疼痛程度,加快患儿术后恢复,提高患儿的手术舒适感.

目的 回顾一例多囊肾并精道动力梗阻性无精症的诊疗经过,探讨该类型无精症的治疗要点.方法 29岁男性无精症患者,彩超资料显示精囊囊性扩张、输精管阴囊段及盆腔段扩张,精液量0.2 ml,初诊射精管梗阻性无精症,予行双侧输精管探查并经尿道射精管切开术治疗.结果 术中发现输精管及附睾管道通畅,左侧输精管往远睾端推注美蓝阻力大,予以行射精管切开,患者术后持续发热,再次行精囊镜检查冲洗控制感染.术后1年精液随访:精液量4.2 ml,无精子.结论 多囊肾并发的无精症,往往为精道动力梗阻性无精症,原因是多囊肾伴随引起的精囊囊性改变、输精管长期扩张,导致精道动力缺乏,这种类型的无精症发病原因往往并不是射精管梗阻,采取射精管切开手术治疗,术后无法恢复精道正常蠕动能力,往往治疗无效.

Objective To evaluate the application value of water-sealed bottle with continuous gas exhaust to maintain pneumoperitioneal pressure in laparoscopic surgery.Methods From May 13,2016 to August 10,2017,clinical data of 54 patients undergoing transperitoneal laparoscopic surgery using water sealed bottle with continuous gas exhaust to maintain pneumoperitioneal pressure (the water sealed bottle group),and 54 cases of transperitoneal laparoscopic surgery using conventional gas exhaust (conventional group) were retrospectively analyzed according to different surgical methods,such as radical resection of prostate cancer,partial nephrectomy and radical nephrectomy of kidney cancer.The times of laparoscopic lens cleaning,operation time,intraoperative blood loss,days of postoperative drainage and the length of postoperative hospital stay were statistically compared between the two groups.Results In the water-sealed bottle group,the times of laparoscopic lens cleaning during radical prostatectomy,partial nephrectomy and radical nephrectomy were significantly less than that in the conventional group (all P＜0.001).The operation time of three types of surgeries significantly differed between the water-sealed bottle and conventional groups (P=0.015,0.046,0.024).The intraoperative blood loss,days of postoperative drainage and the length of postoperative hospital stay of three types of operations did not significantly differ between two groups.Conclusions The water sealed bottle with continuous gas exhaust can maintain pneumoperitioneal pressure,discharge the frog and gas intraoperatively,maintain the working pressure stable,significantly enhance the surgical efficiency and shorten the operation time of laparoscopic surgery.It is a convenient and economical surgical approach,which deserves widespread application in different types of laparoscopic surgeries.

Objective To compare the effectiveness and operative time between inguinal and subinguinal surgical approaches of microscopic varicocelectomy for painful varicocele.Methods Sixty-eight patients with painful varicocele in the Third Affiliated Hospital of Sun Yat-sen University,between July 2011 and June 2013 were divided into 2 groups of inguinal and subinguinal microscopic varicocelectomy.Operative time was recorded.Painful release rate,postoperative uncomfortable rate,relapse rate and complications were followed up.Results The operative time of inguinal and subinguinal microscopic varicocelectomy were (31 ±6) min vs (36±8) min,(P＜0.05).There was no sinificant difference of painful release rate(94.1％ vs 97.1％,P=1.000),postoperative uncomfortable rate (14.7％ vs 5.9％,P=0.427),relapse rate(5.9％ vs 2.9％,P=1.000),scrotal edema (0％ vs 2.9％,P=1.000) and testicular atrothy(0％ vs 0％,P=1.000) between the 2 groups.Conclusion Inguinal and subinguinal microscopic varicocelectomy are both effective for painful varicocele treatment,and the time-consuming of coinguinal approach seems shorter.

目的:对比分析显微精索静脉结扎术对阴囊疼痛不适及不育情况的改善率.方法:2011年3月～2012年12月采用显微精索静脉结扎术治疗2～3度精索静脉曲张患者88例,其中左侧精索静脉曲张66例,双侧精索静脉曲张22例.49例(55.7％)主诉为患侧阴囊疼痛不适,39例(44.3％)主诉为不育.阴囊疼痛不适患者使用视觉模拟评分法评估手术效果,不育患者评估精液质量及配偶自然妊娠情况.结果:术后1年随访,33例患者(67.3％)疼痛完全缓解,18例患者(46.2％)配偶已自然妊娠.疼痛完全缓解率与配偶自然妊娠率的差异有统计学意义(P＜0.05).结论:显微精索静脉结扎术是治疗精索静脉曲张所致阴囊疼痛不适及男性不育的有效方法,其中阴囊疼痛不适患者手术效果较不育患者更佳.

目的 精索静脉曲张是男性不育的首要病因,本课题利用蛋白组学技术筛选精索静脉曲张大鼠睾丸中表达变化显著蛋白,探索精索静脉曲张引起不育的可能分子机制.方法 雄性Wistar 大鼠16只,随机分为对照组和精索静脉曲张实验组.实验组大鼠施行左肾静脉部分结扎术来诱导产生精索静脉曲张,对照组行假手术作为阴性对照.30d后,收集全部大鼠的左侧睾丸.采用原位末端脱氧核苷酸转移酶标记(Tunel)法检测两组大鼠生精细胞凋亡情况,进而比较两组生精细胞的凋亡指数.利用双向凝胶电泳技术(2-DE)寻找两组大鼠睾丸中表达有显著性差异的蛋白质点,然后进行基质辅助激光解析离子化飞行时间质谱鉴定(MALDI-TOF MS).结果 双向凝胶电泳结果显示21个蛋白质点在两组间存在显著性差异.在精索静脉曲张大鼠睾丸中有8个蛋白质点表达上升、13个下降,这些蛋白功能涉及蛋白质合成、加工、降解,基因表达调控,信号转导,能量代谢,凋亡,自由基代谢等.Tunel证实实验组大鼠睾丸中生精细胞凋亡指数显著高于对照组,且本实验筛选出14-3-3ε、hnRNPF以及LZTFL1三种蛋白与凋亡相关.结论 蛋白组学筛选出精索静脉曲张大鼠睾丸差异表达蛋白,并进一步证实精索静脉曲张促进睾丸生精细胞凋亡,其中相关凋亡蛋白对揭示精索静脉曲张引起男性不育的分子机制提供了可能.