钳夹法包皮环切术治疗儿童包茎与皮包过长

包皮过长是儿童最常见的手术适应证 ,美国新生儿约 80 %作包皮环切术 [1]。 1 997年 1月至 2 0 0 0年 1 2月 ,作者采用钳夹法包皮环切术治疗儿童包茎与包皮过长 34例 ,获得良好疗效。现报告如下。1　临床资料1 .1　一般资料　男患儿 34例 ,年龄 6～ 1 2岁 (平均 8.4岁 )。包茎 2 1例 ,包皮过长 1 3例 ,其中 1 6例曾有包皮炎病史。1 .2　手术方法　 0 .5 %碘伏消毒 ,铺无菌孔布。0 .5 %利多卡因溶液 5～ 8ml (加入 1 :2 0万肾上腺素 )作阴茎根部环形浸润麻醉 ,5 min后 ,即行手术。( 1 )在包皮背则正中用 2把蚊式钳夹住 ,纵行剪开包皮至冠状沟…     

包皮切割缝合器、商环及传统包皮环切术的临床疗效比较

目的:比较包皮切割缝合器与商环及传统包皮环切术治疗包皮过长或包茎的手术疗效及安全性。方法:将240例包皮过长或包茎患者随机分为传统包皮环切术组、商环组及包皮切割缝合器组(PCSD)。对比分析三组手术时间、出血量、术中疼痛评分、术后疼痛评分、切口愈合时间、感染、切口裂开、术后水肿、术后出血等情况。结果:在手术时间、术中疼痛评分、术后疼痛评分、切口愈合时间、感染、切口裂开、术后水肿方面,PCSD组都明显优于传统包皮环切术组及商环组(P0.05);PCSD组术中出血量明显少于传统包皮环切术组(P0.05),而与商环组比较未见明显差别;在术后出血方面,三组比较未见明显的差异。结论:PCSD可以明显缩短包皮过长或包茎的手术时间,降低术中、术后疼痛,减少术后并发症。     

门诊包皮环切术患者的心里护理技巧

随着医学模式的改变，患者的心身健康日益受到医护人员的重视。而患者术前的心理健康水平是影响手术效果及术后康复的一个重要因素。因此，做好患者的心理护理，确保手术的顺利进行，永远是我们追求的目标。现就我院外科门诊对包皮环切术患者进行心理护理的技巧介绍如下。     

阴茎延长术合并包皮环切术的护理体会

目的探讨男性阴茎短小合并包皮症行阴茎延长包皮环切术的护理方法。方法对58例行阴茎延长合并包皮环切术患者术前给予心理护理,术中术后密切病情观察及各项护理措施的实施,使其树立信心积极配合治疗。结果全部患者阴茎皮肤切缘平合,无狭窄环,皮肤滑动好,耻骨下区无凹陷,会阴外观生长自然,无明显疤痕,阴茎头外露,阴茎自然显露长度平均为(6.9±1.5)cm,勃起时平均(13.9±1.2)cm,术后回访3~10个月,受术者性生活满意。结论对男性阴茎短小合并包皮手术的特殊性,采取相应的护理措施,消除患者不良心理,使患者树立信心配合治疗,从而提高手术的成功率和患者的满意度。     

商环在糖尿病患者包皮环切术中的疗效观察

目的:评估商环在糖尿病患者包皮环切术中的临床疗效及其安全性.方法:选择54例拟行包皮环切术的糖尿病合并包茎的患者,其中26例采用传统包皮环切术(对照组),28例采用商环包皮环切术(商环组),分析和比较两组患者的手术时间、术中出血量、术后疼痛程度、术后恢复时间和术后感染的发生率.结果:对照组与商环组患者的手术时间分别为(28±7)和(9±2)分钟(P＜0.05),术中出血量分别为(6.2±2.0)和(0.4±0.5)ml(P＜0.05),术后疼痛视觉模拟评分分别为(5.3±1.5)和(3.9±1.3)分(P＜0.05),术后恢复时间分别为(12±4)和(19±5)天(P＜0.05),术后感染率分别为7.7％和10.7％(P＞0.05).与传统组相比,商环组患者的手术时间显著缩短,术中出血显著减少,术后疼痛显著减轻,术后恢复时间显著延长,但术后感染率无明显增加.结论:对糖尿病患者采用商环行包皮环切术,手术时间短、出血少,疼痛轻,术后恢复时间较长但护理方便,术后感染率无明显增加,是一项便捷、安全、有效的手术方式.     

包皮环切术后阴茎头坏死诊治一例报告并文献复习

目的:探讨包皮环切术后阴茎头坏死的临床特性和诊治方法及预后。方法:报告1例包皮环切术后阴茎头坏死患者临床资料,结合文献复习讨论。结果:采用阴茎延长术,切断阴茎浅、深悬韧带并分离部分海绵体脚以延伸阴茎海绵体;同时利用阴茎残端再造阴茎头。术前残留阴茎常态下长度3.5cm,勃起时长度6cm;术后常态下长度6.0cm,勃起时长度10cm;术后均具有感觉和勃起功能。结论:利用阴茎延长术再造的阴茎不但在长度和形态上已接近正常,更重要的是具备良好的感觉与勃起功能,是修复包皮环切术后阴茎头坏死较为理想的方法。     

宫颈电环切除术与冷刀锥切术治疗宫颈上皮内瘤变的临床比较

目的:比较宫颈电环切除术(LEEP)与冷刀宫颈锥切术治疗宫颈上皮内瘤变(CIN)的临床疗效。方法:回顾性分析分别行LEEP(96例)与冷刀锥切术(78例)治疗的CINⅡ-Ⅲ级患者的临床资料,比较两组患者手术时间、术中出血量、脱痂期出血量及切口愈合时间。结果:LEEP组患者术中出血量(13.5±2.6 mL)、手术时间(12.8±1.9 min)分别少于或短于冷刀宫颈锥切组(26.4±3.7 mL;24.9±2.5 min)(P0.01),两组患者脱痂期出血量、术后切口愈合时间无统计学差异。结论:LEEP治疗CINⅡ-Ⅲ级患者较冷刀锥切术治疗术中出血少,手术时间短,值得临床推广。     

两种不同途径子宫全切术的临床效果比较

比较腹腔镜辅助阴式子宫全切术(LAVH)与经腹部子宫全切术(TAH)的临床效果。方法:收集我院2004年6月至2006年1月接受以上两种途径子宫切除术的病例共150例的临床资料。其中LAVH100例(LAVH组),TAH50例(TAH组),比较两组手术时间、术中出血量、术后病率及住院时间等。结果:LAVH组术中出血量、术后病率及住院时间均明显小于TAH组,差异有统计学意义(P＜0．01),但LAVH组手术时间与TAH组比较,差异无统计学意义(P＞0．5)。结论:LAVH创伤小、病人痛苦少,术后恢复快。     

老年吻合器痔上黏膜环切钉合术后肠内营养制剂的应用效果观察

目的:探讨口服肠内营养制剂对老年吻合器痔上黏膜环切钉合术(PPH)术后患者营养状况及排便的影响。方法:选择2013年1月-2015年1月在我院行PPH治疗的老年患者120例,依据随机数字表法将患者分为对照组(n=60)和观察组(n=60),术后对照组通过静脉补液的方式给予常规肠外营养,观察组口服肠内营养剂安素,两组营养支持均维持3-5天。比较两组患者术前和术后3d血白蛋白(ALB)、前白蛋白(PA)、淋巴细胞计数(LYC)、血红蛋白(Hb)的差异,记录两组患者术后首次排便时间和3d内的排便次数。结果:术后第3d,观察组PA和LYC显著高于对照组,差异有统计学意义(P0.05);两组术后排便次数和首次排便时间差异均无统计学意义(P0.05)。结论:口服肠内营养制剂作为老年PPH术后患者的营养支持方式,能满足老年患者的营养需求,改善免疫功能,并且不刺激排便,值得临床推广使用。     

双极等离子电切术治疗宫腔疾病的临床效果分析

目的:探讨双极等离子电切术治疗宫腔疾病的临床疗效及其安全性。方法:选择2010年1月～2012年6月本院妇科收治的子宫内膜息肉和粘膜下肌瘤患者共189例,其中行双极等离子电切治疗者纳入双极组(n=72),行单极电切治疗的患者纳入单级组(n=117)。比较两组手术时间、术中出血量、膨宫液用量、并发症的发生情况并评估两组术后6个月的临床疗效。结果:双极组手术时间、手术出血量、膨宫液用量显著低于单极组(P均<0.05),两组并发症的发生率均无明显差异(P>0.05)。双极组患者术后1月内阴道流血、排液天数显著短于单极组(P<0.05),但两组术后6个月的治疗效果比较无明显差异(P>0.05)。结论:双极等离子电切除术治疗子宫内膜息肉及粘膜下肌瘤具有快速、安全、有效、出血少、手术时间短、膨宫液用量少等优势,并能维持患者电解质平衡,值得临床广泛应用和推广。     

To Cut or Not to Cut: A Modeling Approach for Assessing the Role of Male Circumcision in HIV Control

A recent randomized controlled trial shows a significant reduction in women-to-men transmission of HIV due to male circumcision. Such development calls for a rigorous mathematical study to ascertain the full impact of male circumcision in reducing HIV burden, especially in resource-poor nations where access to anti-retroviral drugs is limited. First of all, this paper presents a compartmental model for the transmission dynamics of HIV in a community where male circumcision is practiced. In addition to having a disease-free equilibrium, which is locally-asymptotically stable whenever a certain epidemiological threshold is less than unity, the model exhibits the phenomenon of backward bifurcation, where the disease-free equilibrium coexists with a stable endemic equilibrium when the threshold is less than unity. The implication of this result is that HIV may persist in the population even when the reproduction threshold is less than unity. Using partial data from South Africa, the study shows that male circumcision at 60% efficacy level can prevent up to 220,000 cases and 8,200 deaths in the country within a year. Further, it is shown that male circumcision can significantly reduce, but not eliminate, HIV burden in a community. However, disease elimination is feasible if male circumcision is combined with other interventions such as ARVs and condom use. It is shown that the combined use of male circumcision and ARVs is more effective in reducing disease burden than the combined use of male circumcision and condoms for a moderate condom compliance rate.     

不同术式治疗新生血管性青光眼的疗效比较

目的：比较不同手术方法治疗新生血管性青光眼（neovascular glaucoma,NVG）的疗效。方法：对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析,其中行单纯睫状体冷凝术20例（A组）,改良小梁切除术15例（B组）,引流阀植入术联合全视网膜光凝术22例（c组）。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况,并随访3～6个月。结果：A组患者出院时的平均眼压为（28．13＋4．83）mmHg,B组为（19．24±5．48）mmHg,C组为（21．22±4．76）mmHg。随访期间,术后A组9例眼压正常,手术成功率45％;B组11例眼压正常,手术成功率73．3％;C组13例眼压正常,手术成功率57．1％。B组手术成功率最高,A组最低。结论：三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳,有视力眼不宜采用此种手术方式;改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式;引流阀植入术联合全视网膜光凝术费用较高。     

169例男性假两性畸形患者的治疗体会

目的:总结男性假两性畸形治疗的临床经验.方法:回顾性分析169例男性假两性畸形患者治疗后的临床资料.结果:169例男性假两性畸形患者,97例选择女性性别,72例选择男性性别,手术平均年龄为7岁.选择男性性别的患者术后阴茎平均长度为5.2 cm,35例出现尿后滴沥,18例再次行手术治疗,8例因阴茎小行手术,5例因尿瘘再行手术修补,5例因尿道狭窄行重吻合术,28例因尿道狭窄需行定期扩张,30例对治疗效果不满意,31例男性担心阴茎小,44例术后社会适应良好.选择女性性别的患者术后无尿失禁及排尿困难,2例再次行手术治疗,其中1例阴蒂肥大,1例尿道阴道瘘,17例因阴道狭窄需定期行阴道扩张(阴道成形术后2例),6例对治疗效果不满意,80例术后社会适应良好的.结论:男性假两性畸形治疗性别选择需在医生的指导下,根据患者及家庭意愿慎重决择,选择男性治疗难度大,术后并发症和社会适应困难比选择女性更明显.     

不同术式治疗新生血管性青光眼的疗效比较

目的:比较不同手术方法治疗新生血管性青光眼(neovascular glaucoma,NVG)的疗效。方法:对接受不同术式治疗的57例57只眼NVG的临床资料进行回顾性分析,其中行单纯睫状体冷凝术20例(A组),改良小梁切除术15例(B组),引流阀植入术联合全视网膜光凝术22例(C组)。比较各组患者手术前后主观眼痛症状、眼压及视力变化情况,并随访3~6个月。结果:A组患者出院时的平均眼压为(28.13±4.83)mmHg,B组为(19.24±5.48)mmHg,C组为(21.22±4.76)mmHg。随访期间,术后A组9例眼压正常,手术成功率45%;B组11例眼压正常,手术成功率73.3%;C组13例眼压正常,手术成功率57.1%。B组手术成功率最高,A组最低。结论:三种手术方法均可不同程度降低新生血管性青光眼的眼压。单纯睫状体冷凝术后眼压控制效果欠佳,有视力眼不宜采用此种手术方式;改良小梁切除术是治疗新生血管性青光眼安全、有效、经济的手术方式;引流阀植入术联合全视网膜光凝术费用较高。     

Male infertility and mitochondrial DNA

The mitochondrial machinery plays a key role in the energy production and maintenance of spermatozoa motility. In this paper 200 idiopathic oligo-asthenozoospermic patients were classified on the basis of rapid progressive motility ("a") and sperm concentration. Mitochondrial enzymatic activity was studied and correlated to the viability of sperm cells. Mitochondrial DNA purified from both motile and non-motile sperm of the same individuals was amplificated using PCR. Results suggested that only motile sperm have organelles functional in oxygen consumption, unequivocally demonstrating that motility depends on the mitochondrial activity. Mitochondrial DNA of oligo-asthenozoospermic patients seemed to present some defects that made DNA unavailable for amplification.     

Male takeover in Colobus vellerosus at Boabeng-Fiema Monkey Sanctuary, central Ghana

We describe a case of male takeover in the ursine black-and-white colobus (Colobus vellerosus). In April 2001, an all-male group attacked and eventually invaded our uni-male study group. Aggression increased following the takeover and the former resident male, severely wounded, became peripheral. The youngest immature received severe aggression from the new males but survived. The immatures mother intervened in most instances of this aggression. Eventually, the former resident male re-established relationships with some of the females and concurrently intervened to protect the immature. Defeated males that stay in their group can contribute to the protection of infants born during their tenure from infanticidal males. The females mated with the new males. Takeovers may be a means by which males acquire groups of females in C. vellerosus.     

Costs and Impacts of Scaling up Voluntary Medical Male Circumcision in Tanzania

Background

Given the proven effectiveness of voluntary medical male circumcision (VMMC) in preventing the spread of HIV, Tanzania is scaling up VMMC as an HIV prevention strategy. This study will inform policymakers about the potential costs and benefits of scaling up VMMC services in Tanzania.

Methodology

The analysis first assessed the unit costs of delivering VMMC at the facility level in three regions—Iringa, Kagera, and Mbeya—via three currently used VMMC service delivery models (routine, campaign, and mobile/island outreach). Subsequently, using these unit cost data estimates, the study used the Decision Makers'' Program Planning Tool (DMPPT) to estimate the costs and impact of a scaled-up VMMC program.

Results

Increasing VMMC could substantially reduce HIV infection. Scaling up adult VMMC to reach 87.9% coverage by 2015 would avert nearly 23,000 new adult HIV infections through 2015 and an additional 167,500 from 2016 through 2025—at an additional cost of US$253.7 million through 2015 and US$302.3 million from 2016 through 2025. Average cost per HIV infection averted would be US$11,300 during 2010–2015 and US$3,200 during 2010–2025. Scaling up VMMC in Tanzania will yield significant net benefits (benefits of treatment costs averted minus the cost of performing circumcisions) in the long run—around US$4,200 in net benefits for each infection averted.

Conclusion

VMMC could have an immediate impact on HIV transmission, but the full impact on prevalence and deaths will only be apparent in the longer term because VMMC averts infections some years into the future among people who have been circumcised. Given the health and economic benefits of investing in VMMC, the scale-up of services should continue to be a central component of the national HIV prevention strategy in Tanzania.     

雄性不育在作物杂种优势中的应用途径分析

雄性不育是植物雄性细胞或生殖器官丧失生理机能的现象,该现象的利用大大提高了杂交种生产的效率。植物雄性不育包含细胞质雄性不育、不受环境影响的核雄性不育、光温敏型雄性不育及化学诱导的雄性不育。这些不育类型也已经被以三系或二系的方式应用于很多作物的杂交种生产中。综述了雄性不育各个途径的研究进展及其在作物杂种优势中的应用。     

雄性不育基因工程及其在蔬菜上的应用

基因工程是创造雄性不育的一种新途径。概述了雄性不育基因工程的主要方法 ,并且对利用基因工程创造蔬菜雄性不育系和恢复系的研究进展进行了综述 ,探讨了这一技术在蔬菜上的应用前景。