宋宁宏医生的科普号

睾丸通过睾丸系膜与阴囊相连，由睾丸系膜将睾丸固定于阴囊。有的胎儿在发育时会产生一侧或两侧睾丸系膜过长，出生后，睾丸与精索的活动度就很大，如果突然遇上用力或猛烈震荡等情况，睾丸与精索就会发生一定程度的扭转，也叫精索扭转。临床表现睾丸扭转发病急骤，多于睡眠中发病，患者一侧睾丸和阴囊会剧烈疼痛。扭转初起时疼痛还局限在阴囊部位，以后会向下腹和会阴部发展，同时还会伴有呕吐、恶心或发热，阴部出现红肿、压痛。1.腹部突然出现剧痛。2.睾丸出现剧痛。3.发生扭转的睾丸在阴囊内的位置显得较正常睾丸高一些。4.患儿可能会出现恶心、呕吐。5.症状出现数小时后，阴囊会红肿、触痛。睾丸扭转的临床表现主要是痛、肿。如果发生在小儿身上，往往更不容易诊断，小儿会有不明原因的厌食、躁动不安，病情一般发展较快。诊断1.突然发生睾丸剧痛，睾丸迅速肿大，并伴有严重的恶心、呕吐。2.睾丸触痛明显，托高睾丸不能缓解或加重疼痛。睾丸和附睾的位置异常或触诊不清楚。3.99mTC睾丸扫描，显示患睾血流灌注降低减少。4.彩色多普勒超声检查：因精索自身扭转而致睾丸血液循环障碍，表现为患侧睾丸增大，回声减低。彩色多普勒血流图显示，其内血流信号明显减少或消失。鉴别诊断1.急性附睾炎患者往往发热，尿检可见脓性细胞。2.阴囊血肿这类病人有明确的外伤史。3.鞘膜积液这是一种慢性发展的疾病，一般情况下不会很痛，可透光。治疗如果发生睾丸扭转，最好的治疗方法就是进行手术。手术方法包括手术复位和手法复位两种。1.手术复位睾丸扭转作出诊断后，应争取时间立即手术复位，争取在症状出现6小时内完成手术。将扭转的睾丸复位后观察血运正常，再行睾丸、精索与阴囊内层鞘膜间断缝合固定，以免术后复发。如术中发现睾丸血循环极差，复位后仍不能恢复，应切除睾丸。2.手法复位一般在病初可以试行。应先给予镇痛剂及解痉剂，半小时后再将横位并上提的睾丸进行轻柔的手法复位。复位成功后再用“丁”字带托起阴囊，让患侧睾丸充分休息。但手法复位后不能防止再次复发。术后可以冰敷，以减轻疼痛和水肿，同时还要用“丁”字带将阴囊支持固定一周，使正常功能逐渐恢复。预防 日常生活中，不少患者对睾丸扭转麻痹大意，疼痛时一忍再忍，以致延误了早期治疗，个别人因此丧失生育能力，酿成终生不幸。因此，青春期及其前后的患者如突然出现阴囊肿胀、疼痛，尤其是青少年，应考虑到睾丸扭转的可能，要及时去医院泌尿外科检查诊治。 睾丸扭转的早期，用徒手复位即能获得良效。但发病时间一长，只能手术治疗。此外，如果不幸发生睾丸扭转，治疗后要请医生做精液常规检查，以了解病侧睾丸及对侧睾丸的功能，这一点对未婚男青年显得更为重要。

1、精液检查的次数,如果精液分析结果是正常的，那么一次检测就已经足够。若精液分析有两次不正常，则需要作进一步的男科检查。2、为何两次精液检查结果差异性很大？首先人的精液参数和血压检查一样，存在一定的生理性波动。其次很多病理性的因素如发热，患病，酗酒、过度劳累，精神压力大等也会影响精液分析结果。此外还有精液检查有没有按照标准流程做，这其中涉及到精液收集过程是否相同，禁欲时间是否相似，送检时间过长以及射精是否充分，实验员的操作是否规范。医师会根据具体情况决定是否需要复查，如果结果虽有差异，但仍在正常范围则无需复查。3、正确理解“正常精液”的意义正常精液仅能表示精子参数超过参考值下限，并不能保证一定能生育。精液参数低于此参考值下限的男性不一定不能生育。精液常规检测仅能80%左右预测使女性怀孕的能力，不明原因不育症在临床上仍有很大比例。目前仍然缺乏客观的可以准确预测妊娠的精子检查方法。4、精液检查异常的处理如果你的精液检查有问题，比如精子浓度，运动力和形态低于参考值。你需要到男科门诊就诊，医师会根据您的病情进行检查和处理。您需要对您生活的方式和工作的环境进行自我筛查，排除如暴露高温或环境有害毒物的影响因素。5、如何看待精子畸形率很多患者带着本院或外院的精子畸形率报告，焦急万分来看男科门诊，因为他们的精子畸形率高达97%甚至100%。他们主要担心几个问题，为什么我的精子畸形率这么高？是不是以后我就再也不能生育了？是不是我的孩子会畸形？这些都是错误的理解。由于精子形态率检查存在一定不客观性，其结果在实验室内部和实验室之间误差较大；其次WHO将精子畸形率96%以下为正常范围，即便100%畸形，仅意味你比正常高4个百分点，这只是一个统计学概念，只要精子数量和活力正常，你们仍然有很大机会受孕。所谓的“畸形率”是我们评价精子受孕能力时使用的一个指标，精子畸形率升高增加自然受孕的难度。不能说精子形态不好，精子的遗传物质就有问题。精子畸形和是否生育畸形后代之间也没有必然联系。6、精液检查注意事项通常在取精前应该有2－7天没有性生活或排精。如果不能手淫采精，可以使用特制的避孕套采集，并非通常用的乳胶避孕套。一定要在取精前向取精者交待，采集射出的全部精液尤为重要。标本采集好一定要及时送检，不超过1个小时内，因为精子活力随时间而下降。

肾癌的研究两篇共同第一作者

扩大前列腺囊外科治疗美国男科杂志发表（一本杂志连续两篇，杂志封面取自我们的文章）-----通信作者

阴茎海绵体血管瘤外科治疗美国男科杂志发表-----通信作者

浅表性阴茎癌保留阴茎头手术美国男科杂志发表----通信作者中华男科学杂志-------通信作者美国uro-today----------highlight

Arch Androl. 2006 Sep-Oct;52(5):383-7.Extraperitoneal laparoscopic radical prostatectomy.Song NH, Wu HF, Zhang W, Hua LX, Qian LX, Xia GW, Feng NH, Yang J, Su JT.SourceDepartment of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.AbstractA total of 28 patients with clinically localized prostate cancer (PCa) underwent extraperitoneal laparoscopic radical prostatectomy (EP-LRP). The mean operative duration was 309 (287-600) minutes. Estimated blood loss ranged from 380 to 1000 (mean 480) ml. At 3 to 5 days postoperatively, the catheter was removed. No open conversion was required and no patient presented postoperative complications. PSA level was less than 0.1 ng/ml at 3 months after surgery in all patients. At a mean follow-up of 10 (6-16) months, there were no biochemical failures. The extraperitoneal technique potentially decreased the risk of intra-abdominal complications and better approximated than open retropubic radical prostatectomy. In conclusion, EP-LRP is an effective, safe and precise technique.PMID:16873139[PubMed - indexed for MEDLINE]MeSH TermsMeSH TermsHumansLaparoscopy/methods*MalePostoperative ComplicationsProstatectomy/methods*Prostatic Neoplasms/surgery*LinkOut - more resources

Glans-Preserving Surgery for Superficial Penile CancerAbstractIn this study, we investigated the safety and feasibility of the glans-preserving surgery for superficial penile squamous-celled carcinoma. Young patients with penile primary tumors exhibiting favorable histologic features were best suited for organ-sparing procedures, enabling them to avoid sexual disturbances. The study included 12 patients, 38 to 53 years of age (median age 46), with superficial lesions involving the glans penis, coronary sulcus or shaft skin. After clinical staging and grading, those patients were offered a glans-preserving procedure to preserve the normal appearance and functional integrity of the glans penis. Of the 12 patients referred, the tumors were TaG1 in 4 patients, TaG2 in 3, TisG1 in 1, TisG2 in 1, T1G1 in 2, and T1G2 in 1.All patients returned to normal sexual activity 1 month postoperatively. Sexual function and sexual satisfaction were well maintained after operation. The cosmetic results were considered satisfying / very satisfying by 83% (10 of 12 patients). Follow-up data were available on 12 patients at a mean of follow-up of 62.5 months. Only one patient had recurrence 6 months after surgery, which was managed by second glans-preserving surgery without recurrence. With careful patient selection and vigilant follow-up, anatomically suitable superficial penile cancer can be offered this glans-preserving surgery, while preserving impact function of penis wherever possible.Key words: penile carcinoma, conservative surgery, cosmesis, sexual function

Arch Androl. 2007 Nov-Dec;53(6):317-24.AZF gene expression analysis in peripheral leukocytes and testicular cells from idiopathic infertility.Song NH, Yin CJ, Zhang W, Zhuo ZM, Ding GX, Zhang J, Hua LX, Wu HF.SourceDepartment of Urology, First Affiliated Hospital, Nanjing Medical University, Nanjing, China.AbstractThe aim of this study was to assess the frequency of AZF microdeletions in peripheral leukocytes and testicular cells in Chinese men with idiopathic infertility. Expression in testicular cells was also determined. In this study, we screened 62 idiopathic infertile patients, in whom karyotype, sperm count and hormonal parameters were evaluated. Genomic DNA was extracted from the peripheral leukocytes. Molecular analysis was performed by two multiplex polymerase chain reactions (PCR) using a set of eight sequence tagged sites (STS) from 3 different regions of the Y chromosome. Total cellular RNA was extracted from the testicular tissue using a Trizol-method. Reverse Transcription (RT) reactions were performed to synthesize cDNA. Amplification of DFFRY, RBM and DAZ genes was performed to analyze their expression in testicular cells. In this cohort, we found 12 submicroscopic deletions (12/62, 19.4%). Nine patients (9/33, 27.2%) were detected in the azoospermic group and three (3/29, 10.3%) in the severe oligozoospermic group. RT-PCR analysis from testicular cells gave normal amplifications for SRY and DFFRY mRNA in 62 idiopathic patients; two patients were negative for RBM expression; no RBM and DAZ were detected for a case; 12 patients had no expression in the AZFc region involving the DAZ gene. Of 12 cases, three patients with normal PCR analysis of DAZ gene on genomic DNA showed no RT-PCR amplification for DAZ mRNA. The use of RT-PCR of specific spermatid expressed genes in conjunction with examining microdeletions using peripheral leukocytes is suggested to avoid the transmission of the Y chromosomal microdeletions from a father to a son via testicular sperm aspiration (TESE), intracytoplasmic sperm injection (JCSI).PMID:18357961[PubMed - indexed for MEDLINE]Publication Types, MeSH Terms, SubstancesPublication TypesResearch Support, Non-U.S. Gov'tMeSH TermsChromosomes, Human, YDNA PrimersGene Expression*Gene FrequencyGenetic LociHumansInfertility, Male/genetics*Infertility, Male/physiopathologyKaryotypingLeukocytes/physiology*MaleRNA/geneticsRNA/isolation & purificationReverse Transcriptase Polymerase Chain ReactionSeminal Plasma Proteins/genetics*Sequence DeletionSex Chromosome AberrationsSex Chromosome Disorders/geneticsTestis/physiopathology*SubstancesDNA PrimersSeminal Plasma ProteinsRNA

男性每20人中就有一位患不育症，男性不育症中至少30%存在基因缺陷。生育基因涉及睾丸发育、精子发生、内分泌和旁分泌的调节。关于精子发生，尤其应关注Yq11区，这里分布着一些精子发生基因。随着ICSI的出现和分子生物学技术的发展，人们发现基因缺陷影响了精子发生，继而引起不育。而ICSI虽为男性不育症的治疗带来了希望，但也可能使这种遗传缺陷传给下一代，因此对基因缺陷的检测并避免传给下一代是迫切要解决的问题。成人精子发生主要取决于胚胎时期睾丸的正常发育，后者决定着支持细胞和生殖细胞的数量和结构特征。在成人，生殖细胞早先位于含有卵泡刺激素及睾酮受体的支持细胞内，支持细胞能够传递内分泌信号。同时，许多旁分泌调节因子在上皮组织和间质中也有重要的作用。精子发生是一个涉及精原细胞有丝分裂产生精母细胞的复杂过程。在减数分裂前时期，精母细胞合成DNA，其染色体经过配对、结合，再经过两次减数分裂后由四倍体变成单倍体的圆形精子细胞，这些精子细胞经历表型的变化而成为成熟的精子。所有这些过程均受基因的调控。原则上，精子产生数或量的缺陷主要由于睾丸发育的缺陷；生殖细胞分裂和分化功能内在缺陷；激素调节通路的缺陷。这些缺陷可引起的少精子、无精子。