目的 系统评价男性精索静脉曲张经显微镜与腹腔镜治疗后的疗效与安全性.方法 以“microsurgical varicocelectomy”,“laparoscopic varicocelectomy”,“painful varicocele”,“varicocelectomy”,“scrotal pain”,“testicular pain”,“显微镜下精索静脉结扎术”、“腹腔镜下精索静脉结扎术”、“精索静脉结扎术”、“阴囊疼痛”、“睾丸疼痛”为主题词及自由词检索PubMed、The Cochrane Library、Embase、Web of science、中国知网(CNKI)、万方数据库(Wanfang)和维普数据库(VIP),检索时间为各数据库建库至2018年11月,对最终纳入的随机对照研究根据Jadad量表的质量评分标准进行质量评价,非随机对照研究根据纽卡斯尔-渥太华评分(NOS)进行质量评价,运用meta分析比较两种手术方式在治疗精索静脉曲张疗效与安全性.结果 经过仔细的搜索和排除后,最后纳入7篇研究,其中3篇随机对照研究,4篇非随机对照研究.Meta分析结果显示:MV比LV对术后阴囊疼痛缓解疗效更好[OR=5.05,95％CI=(1.98,12.84),Z=3.40,P=0.0007].MV的手术耗时长于LV[WMD=21.20,95％CI(10.02,32.38),Z=3.72,P=0.0002].MV术后恢复时间短于LV [WMD =-0.20,95％CI(-0.33,-0.07),Z=2.95,P=0.003].MV术后阴囊水肿明显少于LV [OR=0.24,95％CI=(0.09,0.63),Z=2.91,P=0.004].MV术后精索静脉曲张复发明显少于LV[OR =0.15,95％CI=(0.06,0.42),Z=3.64,P=0.0003].结论 MV治疗精索静脉曲张对术后阴囊疼痛的缓解比LV更佳,MV术后阴囊水肿、精索静脉曲张复发比LV明显减少,然而手术时间比LV长.我们认为经显微镜手术结扎治疗精索静脉曲张术后阴囊疼痛缓解的疗效与安全性优于腹腔镜手术.

Objective Nephron﹣sparing nephrectomy has gradually become the preferred treat﹣ment for patients with small renal tumors. Controlling the warm ischemic time is vital for the pro﹣tection of renal function. T his article will discuss the feasibility ,safety and prospect of retroperitone﹣al laparoscopic thulium laser zero ischemia partial nephrectomy for small renal tumors. Methods T wo patients with small renal tumors treated by thulium laser zero ischemia resection were reported in our center ,including the effects of surgeries and 5﹣year follow﹣up data ,and then related literature was reviewed. Results T wo cases of renal tumors were successfully resected by thulium laser without ischemia. T here were no massive hemorrhage during operations and no significant decrease in renal function after operations. Pathological examination showed that one case was renal clear cell carcinoma (Fuhrman grade 1) ,and another was papillary renal cell carcinoma (type I). Both of ca﹣ses showed negative margins ,and there was no recurrence within 5 years. Conclusions Retroper﹣itoneal laparoscopic thulium laser nephron﹣sparing nephrectomy is a safe , feasible and promising method for the treatment of small renal tumor.

目的 探讨青春期后腮腺炎引起的睾丸炎导致的无精子症患者生育遗传学后代的可行性及其结局分析.方法 对13名就诊于本院的青春期后睾丸炎引发的非梗阻性无精子症患者行显微睾丸取精术,成功取到精子者行卵细胞胞浆内单精子注射(intracytoplasmic sperm injection,ICSI),术后随访6周,观察患者恢复情况及其配偶妊娠情况.结果 13例青春期后睾丸炎引发的非梗阻性无精子症患者查染色体核型及Y染色体微缺失均正常,在睾丸穿刺活检未见精子后,均通过显微睾丸取精术找到少量精子.患者的平均年龄(32.31±5.36)岁,平均睾丸体积(10.38±1.45)mL,平均血清卵泡刺激素浓度(follicle-stimulating hormone,FSH)(26.43±17.78)mIU/mL,平均血清黄体生成素浓度(luteinizing hormone,LH)(8.90±6.83)mIU/mL,术前平均睾酮(testosterone,T)(3.00±0.81)ng/mL.平均手术时间为(64.85±7.81)min.其配偶平均年龄(30.69±5.33)岁,取卵后行ICSI,受精率为(78±22.20)％,优胚率为(45±25.11)％,临床妊娠率为69.23％(9/13).术后随访1月,所有患者未出现阴囊血肿、感染等并发症,患者术后血清总睾酮水平为(3.05±0.75)ng/mL,与术前睾酮水平进行比较,差异无统计学意义(P>0.05).结论 青春期后睾丸炎引发的无精子症患者显微取精成功率高,无明显并发症,同时配合ICSI技术,大部分可生育自己遗传学意义的后代.

In recent years,the evolution of robotic surgery enabled andrologists to perform micro-surgery for male infertility.Current evidence suggests that da Vinci Surgical System provides encouraging outcomes through magnification and three-dimensional visualization.Besides,robot-assisted surgery has ad-vantages in shortening hospital time as well as reducing blood loss and postoperative complications when compares with the open surgery.Nowadays,robot-assisted vasectomy reversal,robot-assisted vasoepididy-mostomy,robot-assisted testicular sperm extraction,robot-assisted microsurgical varicocelectomy and robot-assisted targeted-denervation of the spermatic cord have been performed.This article provides the history and application of robotic assistance for microsurgical procedures in the treatment of male infertility and andrology.

Objective To explore the feasibility of biological fatherhood in patients with nonmosaic Klinefelter syndrome.Methods Serum follicle-stimulating hormone and luteinizing hormone levels were 37.34 IU/L and 15.69 IU/L respectively in the patient who came for treatment in Tongji hosptial.Testosterone level was 2.13 ng/ml.Peripheral karyotype identifies cells with a 47, XXY complement.No Y chromosome microdeletion was found.Microdissection testicular sperm extraction (micro-TESE) was performed for the patient with Klinefelter syndrome on the day before oocyte retrieval during a programmed in vitro fertilization cycle in our hospital.The couple was followed up visits for one month to observe the complications and pregnancy.Results Spermatozoa were observed in our surgical procedures.Neither scrotum hematoma nor infection was found after surgery.Testosterone level was reduced in first month.Clinical pregnancy was found 4 weeks after the procedure.Conclusions Patients with nonmosaic Klinefelter syndrome had chances of fathering children by the use of micro-TESE/ICSI techniques.

Objective We report efficacy and security to en bloc resection non-muscle invasive bladder cancer by 1 470 nm laser.Methods We treated 9 cases non-muscle invasive bladder cancer by 1 470 nm laser during May 2014 to November 2016, and observed its efficacy and safety.Results All operations were complete safety.There were no serious complications.There was no recurrence in situ in short-term follow-up cases.Conclusions The process to en bloc resection non-muscle invasive bladder cancer by 1 470 nm laser is safe and feasible.

Spermatozoa cryopreservation is an important method to reserve the fertility of male,and it is widely used in human assisted reproduction.However,the structure and function of spermatozoa will be damaged when frozen in the long time.So it is one of the most significant researches to explore the appropriate cryopreservation.This review summarizes the domestic and international research development of spermatozoa cryoprotective agents and cryopreservation.

Objective To study myogenic differentiation of rat bone mesenchymal stem cells (BMSCs) in vitro for obtaining the available seed cells to treat erectile dysfunction (ED). Methods Rat BMSCs were isolated and cultured from the femur and tibia of Sprague Dawley (SD) rat. The expressions of CD49d, CD73, CD90, CD105, CD106 and CD31, CD34 and CD45 in the isolated BMSCs were analyzed by flow cytometry. The fourth passage of BMSCs were further induced and differentiated into myogenic cells by conditioned medium. Results Mesenchymal stem cell surface markers CD49d, CD73, CD90, CD105 and CD106, were detectable in the isolated cells but no detectable for the expression of CD31, CD34 and CD45. Myogenic differentiation cells were identified by the expression of alpha-smooth muscle actin (α-SMA) and Desmin. Conclusion Rat BMSCs were successfully isolated and direct differetiated into myogenic cells in vitro. They could be used as autogenous BMSCs and gene modified BMSCs for ED therapy.

Objective To report the effects of the transurethral prostate vaporization and enuclea-tion with a straight optical fiber and 1 470 nm laser,as transurethral resection of the prostate (TURP),for the treatment of benign prostatic hyperplasia (BPH). Methods Twenty-four cases of BPH underwent the transurethral prostate vaporization and enucleation with a straight optical fiber and 1 470 nm laser,as TURP operating methods,from 2014.1 to 2014.6.The mean age of patients were (68.8±5.8)years, and mean prostatic weight were (68.1 ±27.2)g.All patients had low urinary tract symptoms relate to BPH (4.3±2.8)years. Results All operation had been finished successfully.There was no blood transfusions were needed during operation.The operation time was (94.5±34.1)min,and amount of bleeding was among 10-80 ml.After operation,bladder irrigation time was (1.5±0.7)d,urethral cathe-ter time was (4.3±1.2)d,hospital stay (5.1±1.3)d.Follow-up six months later,IPSS score and qual-ity of life score was significantly improved (P<0.05). Conclusions The transurethral prostate vapori-zation and enucleation with a straight optical fiber and 1 470 nm laser,as TURP operating methods, is a safe and effective minimally invasive treatment for BPH.

目的研究大鼠脂肪干细胞(Adipose-Derived Stem Cells, ADSCs)体外定向诱导分化为血管内皮细胞(vascular endothelial cells, VECs)的可行性.方法取SD大鼠腹股沟区脂肪组织获取ADSCs进行体外培养并检测其多向分化能力,取4代细胞在血管内皮细胞生长因子(vascular endothelial growth factor, VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor, bFGF)诱导下向内皮方向分化,检测内皮细胞标志物血管性假血友病因子(Von Willebrand Factor, vWF)表达.结果 ADSCs在体外能迅速扩增,具有多向分化的能力.在 VEGF、bFGF 诱导下,ADSCs能迅速分化为VECs,大多数细胞vWF阳性表达,与阳性对照组相似.结论 ADSCs在特定诱导环境下可以分化为VECs,有望成为组织工程领域内治疗勃起功能障碍(erectile dysfunction, ED)新的种子细胞来源.

无精子症(azoospermia)是指精液常规检查中未发现精子,离心沉淀及涂片染色检查仍未见精子,检查2次以上,且排除逆行射精和不射精情况.临床上根据输精管道是否堵塞,进一步分为梗阻性无精子症(obstructive azoospermia,OA)和非梗阻性无精子症(non-obstructive azoospermia.NOA).其中非梗阻性无精子症是各种原因导致的生精功能障碍,预后差,过去只能接受供精或领养.

一、慢性盆腔疼痛的诊断与分类 慢性疼痛是指至少持续3个月的疼痛.它与中枢神经系统(central nervous system,CNS)的改变有关,这些改变可能影响了机体对刺激的感受,导致机体产生痛觉异常(对非疼痛刺激感到疼痛)和痛觉过敏(对疼痛刺激感到超常的疼痛).盆腔肌群等一些核心肌群可能会出现痛觉过敏并伴随多个触发点,其他器官也可能会出现感觉敏感,如子宫变敏感会出现性交痛和痛经,结肠变敏感导致肠易激综合征等.