The Research Of Innovation In Diagnosis And Treatment Of Seminal Tract Stricture Or Obstructive Disease And Standardization

Male seminal tract,just as its name implies,which is the male sperm run channel.Sperm born of testicular seminiferous tubule,and then through the epididymis,vas deferens,ejaculatory duct and urethra,send the mature sperm in vitro.Seminal tract disease is one of the most common type,whic is also one of the most important and obstructive diseases,as long as any obstruction,sperm operation and discharge occur disorder,can cause infertility.Seminal tract obstruction may be caused by two kinds of congenital and acquired factors.Congenital obstruction include sex hypoplasia of epididymis;Congenital vas deferens dysplasia or absent;Congenital vas deferens atresia;Ejaculatory duct obstruction,etc can cause congenital seminal tract obstruction.Then nature obstruction reasons are very common,such as epididymitis,iatrogenic injury of vas deferens and seminal vesicle phlogistic,seminal vesicle stone,which causes obstruction,Seminal tract obstruction is one of the important influence factors of male infertility.Due to reasons such as congenital anatomical sex disease,its diagnosis and treatment still exist certain difficulties.How to accurately check the seminal tract obstructive disease,judgment,how to adjust measures to local conditions to develop treatment strategies and treatments,is one of the important problems we face.Especially in the domestic,Jing Dao disease diagnosis and treatment level of developed countries,there are still a large gap,on the other hand,we also for Jing Dao the occurrence and development of specific diseases with keen interest,seminal vesicle stone now think and Jing Dao obstruction and microbial infection,there is a close relationship,so look for the cause of these diseases is also our another issue of concern.This paper use of changhai hospital uropoiesis surgical department has accumulated 6 years Jing Dao obstructive disease data,fitting for different part Jing Dao obstruction disease classification,discuss the reasonable diagnosis and treatment method,at the same time for the Jing Dao calculi obstruction leads to the representation of the disease,in addition to strengthen obstruction another important incentives-correlation analysis of microorganisms,with its to discuss the reason of this kind of disease,tries to put forward solution and guide clinical application,for the Chinese seminal tract obstructive disease and treatment basis for the occurrence and development of seminal vesicular stone and way.Part one objective: to establish a simple and practical to Jing Dao obstructive disease diagnosis and management of the system,and the different types of Jing Dao obstructive disease follow-up management system is established.Methods: using Microsoft ACCESS 2003 software to establish "Jing Dao obstructive disease patient information collection and follow-up database",mainly includes the basic information of the patients,such as age,incidence,obstruction,operation method,imaging data and follow-up information recorded including data terminate(e.g.,spouse pregnant),and hope to be able to query through a variety of conditions positioning and export target group information.Is the preservation,the standardization of the follow-up of patient information.Results: has recorded 39 cases epididymal sperm obstructed without information,vas deferens obstruction in 11 cases,patients with ejaculatory duct obstruction and jing 504 cases of patients with blood,before the patient follow-up rate is low,many patients data cannot be used,at present,we can through statistical information entry of nearly 90% of patients,to facilitate our follow-up study.At present has been completed on the follow-up study,patients used in paper data.Conclusion: should be established in line with the clinical diagnosis and treatment process,facilitate seminal tract of diagnosis and treatment of diseases,postoperative follow-up and research for the patient at the same time,improve the operation method,plays an important role.The second part: objective to analyze the Chinese crowd epididymis obstructed the clinical characteristics of patients with sperm,looking for favorable and unfavorable factors associated with surgical treatment,to explore the effect of prognosis of surgery,improve the efficiency of operation and method of statistics the effectiveness and safety of surgery,clinical operation to provide experience for future.Methods: between January2001 and February 2010 between the lines of microscope vas deferens epididymis anastomosis in patients with the clinical data of 39 cases,and the clinical data such as obstruction,obstruction time,intraoperative biopsy smear and surgical anastomosis were analyzed,and explore the efficacy and safety of the operation,and puts forward the clinical characteristics of diagnosis and treatment.Results: the operation time was 122 minutes to 238 minutes,the average operation time was 186 minutes.Line of bilateral microscope vas deferens epididymis anastomosis 32 cases,unilateral anastomosis in 5cases,the rest 2 cases because of epididymis dysplasia,obviously not line.39 cases of epididymal sperm obstructed without found the scrotal exploration line epididymis head,body or tail obstruction of 37 cases,2 cases epididymal dysplasia.Found in 37 cases inepididymis incision discharge sperm,in which 32 cases were performed under a microscope the longitudinal two nested vas deferens epididymis anastomosis,5 patients with unilateral anastomosis,because only in one side,discovered that sperm,on the other side epididymis pipeline development is poorer,line only one match.The remaining 2cases,because of the development on both sides of the epididymis are poor,tiny epididymis pipe,smear no sperm,did not match.Patients are followed up postoperatively,postoperative follow-up of 3 months,follow-up once every 3 months follow-up.Follow-up time is 9 ~ 20 months.Among them,according to the epididymis anastomosis site is different,the results are as follows: microscopic vas deferens epididymis end anastomosis 28 cases,body anastomosis,6 cases head(3 cases).Semen examination in23 cases(62.1%)patients respectively in the check in 3 ~ 12 months after semen live sperm,sperm in postoperative 3 months live sperm in 11 cases,6 months after semen check live sperm)in 9 cases,9 months after semen live sperm in the check in 2 cases,1case of semen live sperm in the check after 12 months;The tail and body,head of anastomosis after rate was 71.4%(20/28)and 50.0%(3/6)and 0%(0/3),;Sperm density of o.3 x106 ml ~ 24 x 106 / ml,forward movement(a + b)sperm percentage by 0% ~45%.Spouse gestation in 7 cases(18.9%)patients.Conclusion: microscope vas deferens epididymis anastomosis should be strict operation indication,the part of the epididymis anastomosis,epididymis smear epididymis liquid quality and anastomosis without tension is the key to a successful operation.The third part: objective to explore the microscope vas deferens anastomosis combined laparoscopic surgery for the feasibility and effectiveness of the vas deferens obstruction.Methods: I division in March 2010-February 2013 were iatrogenic injury of bilateral vas deferens sperm to no 11 cases,patients age 20-33 years old,patients with preoperative all because there was no sperm in outpatient clinic,I always have a history of pelvic surgery,7 cases of childhood did open bilateral inguinal hernia repair,4 cases underwent bilateral cryptorchidism drop fixation,lines of semen routine inspection and the measurement of sex hormones and by transrectal prostate,seminal vesicle lumen ultrasound and pelvic CT or MRI examination,semen routine inspection three times were confirmed as no sperm,sex hormone levels and seminal plasma biochemical examination not seen obvious abnormity,semen volume is normal,by transrectal ultrasound prostate,seminal vesicle not seen obvious abnormity,on bilateral testicular size,texture,normal bilateral epididymal untouched enlargement or abnormal nodules,bilateral vas deferens can hit within the scrotum.Inform patients may be suffering from obstructive no sperm,it is recommended that the bilateral inguinal region detection operation,clear area of obstruction and causes.Results: the intraoperative bilateral inguinal region detection,in 6 patients with intraoperative bilateral vas deferens visible inguinal canal section of atresia,atresia length range 1-2 cm,resection of the closure section line bilateral vas deferens end to end anastomosis under microscope.5 cases in the inner ring mouth saw that vas deferens was from the broken end,cannot find and distal vas deferens,joint Laparoscopic exploration abdominal cavity,after separation,release the vas deferens,the groin outer ring diverted out of the mouth,shorten the vas deferens,vas deferens end to end anastomosis under microscope,including 2 cases with unilateral vas deferens abdominal segment defect is longer,can’t match,line on one side of the vas deferens end to end anastomosis.6 cases of postoperative patients semen routine check see sperm.The fourth part: case analysis retrospectively analyzed the hospital uropoiesis surgical department vas deferens sperm obstructed no 1 case,microscope combined laparoscopic surgery vas deferens obstruction sex are discussed the feasibility and safety of no sperm.Methods: 27 patients,always did bilateral inguinal hernia repair,intraoperative probe found that bilateral vas deferens is broken.Line of laparoscopic vas deferens free and vas deferens anastomosis under microscope.Patients who can be found that sperm,sperm smear vas deferens anastomosis under microscope,results: 5 months after review of semen routine,discovered that sperm,spouse pregnant 6 months after surgery.Discuss whether such patients require surgical treatment,both at home and abroad is controversial,but for the patients to restore confidence and self-esteem,spouse is vital ability to conceive naturally.The fifth part: objective: to study the application of seminal tract endoscopic treatment seminal tract obstructive diseases at the end of the feasibility and effectiveness of ejaculatory duct obstruction sex no sperm,and summarizes the standard operation procedure of the seminal vesicle mirror.Methods: into the group of our hospital from May 2007 to November 2014 line Jing Dao,a total of 504 patients with endoscopic surgery,in which the blood fine patient 419 cases,85 patients with ejaculatory duct obstruction sex no sperm,fine in patients with preoperative blood at least 4 weeks of oral antibiotics,sperm ejaculatory duct obstruction sex without giving seminal plasma biochemical and semen routine and sex hormone level examination,all patients withpreoperative via rectum ultrasound,and pelvic CT or MRI.Results: according to the intraoperative can see,we can opening ejaculatory duct and seminal vesicle,classified into four categories,A,B,C,D.A class can be found beside the verumontanum ejaculatory duct openings,class B into verumontanum cavity can be in two side found suspected ejaculatory duct openings,only on the surface of A layer of mucous membrane cover,class C after entering verumontanum cavity cannot find and ejaculatory duct openings on both sides,to under the zebra godet channels and openings.Class D due to anatomical variants of such reason,can’t find ejaculatory duct openings.It was found that in patients with blood essence,A,B,C,D four to eight accounted for(2%),32(8%),341(81%),38(9%).For patients with ejaculatory duct obstruction sex no sperm,0(0%),respectively),3(3%),60(71%),33(26%).Ejaculatory duct obstruction sex no sperm can detect found that patients with ejaculatory duct openings relatively low in patients with blood essence,prompt inherent anatomical sex anomalies and other factors.In the seminal vesicle of patients with blood fine microscopically,mainly includes the seminal vesicle stone of 19(5%),seminal vesicle bleeding(95%),362 mucosal lesions in 209(55%),ejaculatory duct opening narrow and 312(82%),seminal vesicle cystadenoma(0.2%),1 hemangioma 1(0.2%).Ejaculatory duct obstruction sex no refined disease patients,8(13%),seminal vesicle stone of seminal vesicle bleeding(24%),15 mucosal lesions in 21(33%),ejaculatory duct opening narrow 57(90%),seminal vesicle cystadenoma and hemangioma did not see.Bleeding complications including urinary tract infections,seminal vesicle,epididymitis and retrograde ejaculation.No postoperative erectile dysfunction.Discussion: seminal tract endoscopy is seminal vesicle at the end of diagnosis and treatment of obstructive diseases such as blood with fine and ejaculatory duct obstruction sex sperm and other effective measures,the current lack of unified specification into the process of the mirror,at the same time,the lack of large sample Jing Dao endoscopic surgery in patients with statistics and analysis,in general,seminal tract endoscopy for seminal tract obstructive disease patients,the overall is safe and effective.Fewer complications,no serious concurrent disease,patients’ recovery time is short,good curative effect.The sixth part: seminal vesicle stone and the relativity analysis of genitourinary tract microbial research.Objective: to study the correlation of seminal vesicle stones and urinary tract microorganisms.Methods: to collect the analysis of the components of seminal vesicular stone,the genomic DNA extraction of sample(seminal vesicle stones,urethra swab,seminal plasma),will these samples of DNA for PCR,build the PCR products of gene library and flora analysis and sequencing analysis.First get samples:blood with seminal vesicle calculi patients clinical specimens,including the seminal vesicle or if ejaculation,seminal plasma,and urethral swabs.Gather specimens after the seminal plasma washed with PBS,centrifugal,precipitation,extraction of DNA.Stone cracking after soaking liquid grinding,through DNA extraction kit extract the DNA in the samples,and then respectively using clinical more common genitourinary tract pathogen: 18 s,bacteria,fungi,16 s and mycoplasma/characteristics of chlamydia DNA,PCR is confirmed samples in the presence of the above three kinds of microbial contamination.Detected in seminal vesicle stone of a large number of microorganisms,mainly bacteria,some samples contain mycoplasma,does not contain fungus.Look from mycoplasma type,seminal vesicle stone of microbes mainly comes from urinary tract infections.Role of main part of mycoplasma is humanoid mycoplasma,urea mycoplasma role is smaller.Is main part of bacteria staphylococcus aureus,micro coli may shape plays a main role to the environment.Different patients have different distribution of the flora,but all point to the acidic training environment and staphylococcus aureus.