作者要感谢KMMU第二附属医院提供与这项工作相关的病例和医疗记录。这项研究没有资金支持。

本文所述手术方法已获得昆明医科大学附属第二医院伦理委员会批准，患者手术视频的使用已授权。从患者那里获得知情同意书，并使用患者数据进行介绍。
1. 操作仪器
<ol><li>确保显示摄像头系统和钬激光器工作正常。</li>
</ol>2. 操作准备
<ol><li>使用以下纳入标准选择本研究的参与者。<ol><li>所有被诊断患有无精子症或少精子症并同意手术的患者。</li>
		<li>精液体积小于 1.5 mL，pH<7.2。精浆果糖 ≤13 μM/单次射精。</li>
		<li>磁共振成像（MRI）显示射精管区域有囊肿，双侧精囊腺肿大（图1）。 注意:很难通过成像准确识别前列腺囊肿和射精管囊肿。当精囊扩张的宽度大于 17 mm10 时，我们通常通过手术确认诊断。</li>
		<li>性激素水平在正常范围内。睾丸体积大于 15 mL（单个睾丸体积）。 注意:睾丸体积 >15 mL 的目的是排除由某些睾丸因素引起的无精子症。使用超声报告数据和 Lambert 公式测量睾丸体积:长 x 宽 x 高 x 0.71。</li>
		<li>没有影响手术安全性的疾病，如高血压和高血糖控制不佳、呼吸系统疾病等。</li>
	</ol></li>
	<li>使用以下排除标准将参与者排除在本研究之外。<ol><li>有尿道狭窄、急性尿路感染、严重凝血障碍或其他麻醉禁忌症的患者。</li>
		<li>睾丸体积小于 12 mL。</li>
	</ol></li>
	<li>手术前 30 分钟静脉注射抗生素以防止感染。通常，使用 1.5 g 头孢呋辛钠和 100 mL 0.9% 氯化钠溶液。</li>
</ol>3. 操作程序
<ol><li>使用舒芬太尼 （0.3 μg/kg）、丙泊酚 （2 mg/kg） 和罗库溴铵 （0.8 mg/kg） 将患者置于截石术中进行麻醉诱导。药物起效后进行气管插管，连接麻醉机进行机械通气。</li>
	<li>用异丙酚（2mg / kg / h），瑞芬太尼（0.15μg/ kg / min）和2%七氟醚维持，以达到BIS值40-60。间歇性注射罗库溴铵以促进正性肌力松弛。用碘水对下腹部和会阴区域进行 3 次消毒。</li>
	<li>将精囊镜连接到显示系统。将内窥镜插入尿道外口，小心地将其推进到后尿道。尿道粘膜看起来光滑而微红，证实了尿道在视野内的准确定位并延伸到后尿道。</li>
	<li>如果成功，检查尿道的凸起结构（称为精丘）是否可见。在精髓丘的两侧，检查射精管的两个小开口（图2A）。</li>
	<li>引导一根电线 （Bard） 穿过患侧的射精管开口，进入射精管囊肿。在手术过程中观察充满浑浊液体的重要区域（图2B）。</li>
	<li>用生理盐水冲洗囊肿，直至视力清晰，检查精管是否有异常开口。通过异常的射精管囊肿开口进入同侧精囊，显示多个蜂窝状导管腔（图2C）。</li>
	<li>使用 40 W 钬激光，将射精管的直径扩大到约 5 mm，促进改善冲洗液的循环并提供更清晰的视野（图 2D）。</li>
	<li>沿尿流方向切开射精管口，可能有利于保留抗尿反流机制。</li>
	<li>识别并探索患侧异常射精管开口的对称位置。</li>
	<li>进入健康侧的精囊进行进一步探索。轻轻将其插入囊肿左下方和右侧的精囊中。需要注意的是，确切的位置可能会有所不同（图2E）。</li>
	<li>使用钬激光精确切开和扩大对侧人工开口，使内窥镜顺利通过。这标志着手术的关键终点，两侧输精管中的精子通过受影响侧射精管的开口有效释放（图2F）。</li>
	<li>浸泡 Fr18 导管并用生理氯化钠连续冲洗，以防止血凝块阻塞导管。</li>
</ol>4. 术后护理
<ol><li>术后第1天， 连续冲洗膀胱6小时，并根据需要补充葡萄糖和电解质。</li>
	<li>在手术后第2 天拔 除导管。确保患者在手术后没有明显的疼痛;相反，他们能够忍受导管的主要不适，无需药物即可控制。术后不要对没有预先存在感染的患者使用抗生素。住院2天。</li>
	<li>指导患者增加饮水量，尿频，出院后尽快射精，目标是每周1-2次。此外，密切观察精液量。</li>
</ol>5. 跟进
<ol><li>在手术后第 3个月进行精液分析，以确保满足呕吐时间要求，并在3个月后主要通过电话访谈进行随访。</li>
	<li>使用自动精子活力测试仪和自动精液血浆生化仪进行精液样本。将手术前获得的精液分析结果与术后第 3 个月的精液分析结果进行比较。</li>
</ol>6. 统计分析
<ol><li>使用GraphPad软件分析结果，并表示为平均值±标准差。 使用Shapiro-Wilk检验进行正态性检验。如果术前和术后差异呈正态分布，则使用配对 t 检验进行分析;否则，请使用非参数检验 （Mann-Whitney）。通过配对 t 检验分析术前和术后数据之间的差异。当P<0.05时，统计学差异显著。</li>
</ol>

精囊镜激光辅助手术治疗射精管阻塞

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作者声明他们没有竞争利益。

TURED是治疗射精管囊肿引起的射精管阻塞的主要手术方法，其主要手术方式是用电切口切除囊肿后，以释放压力并渣滓精管11。研究对象在访问期间被问及他们的病史，并且都有正常的性活动频率（每周 1-2 次），没有性功能障碍或血精症。术前精液检查显示，均有精子，但精子数量少于正常值，精液量减少。结合患者的睾丸体积、精浆果糖和影像学检查，足以支持精膜远端不完全梗阻的诊断。在手术过程中，习惯上进行精囊切除术以充分暴露射精管。文献报道，该手术精液参数改善率为44.5%-90.5%，配偶术后受孕率为13%-31%12,13,14。文献报道的并发症发生率约为13%-26%15，主要并发症包括尿路反流、附睾炎、逆行射精、膀胱痉挛、尿失禁、尿道直肠瘘和术后出血。手术彻底破坏了精管远端的抗尿反流机制，使精管与尿道完全相连，增加了尿液流向精囊腔的风险。笔者认为，上述并发症的发生不利于患者保持生育能力。
近年来，随着内窥镜设备的创新和技术的进步，利用内窥镜对精髓性疾病进行深入诊断和治疗成为可能。越来越多的学者将4.5Fr-9Fr输尿管镜作为精道内镜检查应用于难治性血精症、EDO、精囊炎等远端精路疾病的诊断和治疗，发现术后血精症和会阴疼痛的症状可以明显缓解4,16,17,18 .此外，精液参数可不同程度改善，很少发生附睾炎、逆行射精、尿失禁、直肠损伤等术后并发症。与TURED手术相比，具有明显的优势，被认为是诊断和治疗EDO，精囊结石和顽固性血精症疾病的一种更安全，更有效的新方法4,16,17,18。值得注意的是，钬激光的穿透深度非常浅（0.4毫米）19，这是一个有趣的特性，可以降低TURED引起的严重并发症（如直肠损伤）的风险。对于射精管囊肿合并EDO和生育需求的患者，除了缓解梗阻和压迫外，保护生育能力尤为重要。
保留verumontanum结构可以更好地模拟正常的生理解剖结构。然而，维持 verumontanum 可能会增加术后远端射精管瘢痕形成的风险，导致复发性梗阻或精液量减少。
我们使用了精囊镜和钬激光，没有切除精囊，到达射精管囊肿的内部。共对5例射精管囊肿合并EDO患者进行内镜辅助远端导管血流改变治疗，本研究取得良好效果。这种简化的手术方法提高了安全性并最大限度地减少了术后并发症。以下是我们的程序步骤:首先，通过尿道外口将 6Fr 精囊镜引入 verumontanum 附近，定位患侧射精管的开口并将导丝引入囊肿。这一成功的手术保留了verumontanum，有效地维持了远端射精管中的抗反流机制。因此，它显着降低了附睾炎、睾丸炎和逆行射精等术后并发症的风险。此外，钬激光将患侧射精管的开口沿尿道方向扩大至约 5 mm，从而实现更清晰的手术区域并更好地控制切割深度。无需担心直肠计算，这种方法显着降低了术后射精管开口闭合的可能性。它简化了手术步骤，提高了操作安全性和效率。最终，在囊肿内创建一个窗口以进入对侧精囊，然后使用钬激光将开口燃烧并扩张至 5 毫米，将对侧射精管重定向到囊腔。这种修改保留了健康侧射精管的开口，并增加了新的精液流出通道，降低了术后精液量减少的风险。
术后均未发现明显并发症，术前后精液量、精子浓度、精液果糖水平均有统计学显著改善（P<0.05）。因此，我们确认了该手术的安全性和有效性，它不仅保留了脓膜，而且还消除了囊肿引起的阻塞和压迫。最重要的是，它改善了患者的异常精液参数。
目前，该技术仅尝试治疗射精管囊肿引起的射精管梗阻。它还为结石、前列腺囊肿、苗勒管囊肿、前列腺囊肿和炎症引起的射精管阻塞相关问题提供了有价值的参考。然而，由于样本量小且缺乏对照组，本研究结果存在局限性，限制了其在特定背景之外的普遍性。对于该领域的未来研究来说，通过雇用更多的参与者并包括适当的控制措施来解决这些局限性至关重要，以便获得可以应用于不同情况的更可靠的结果。
简而言之，精囊镜联合钬激光是治疗射精管囊肿引起的EDO患者持续性少精子症或无精症的极好选择。

射精管梗阻是男性生殖系统的一种罕见疾病，据报道发病率为 1%-5%1,2。射精管囊肿是射精管阻塞的主要原因。典型EDO患者的精液检查显示四个显着特征:1.精液量小于2 mL，梗阻严重程度与精液量减少直接相关;2.少精子症，双侧完全梗阻导致无精子症;3.精液pH值降低;4. 精浆果糖水平降低，有时甚至降至 0 mM/L3.EDO引起的男性不育症可以通过手术治疗，保守治疗效果较差4。过去，主要方法是经尿道切除射精管。尽管这种方法具有减少创伤和减少术中并发症等好处，但手术切除藰膜会破坏远端射精管的正常生理结构。这反过来又增加了术后并发症的风险，如尿流、附睾炎、逆行射精和尿失禁5。同时，手术过程中的热量产生可能导致射精管、精囊甚至直肠的损伤，电切口的热效应可能会引起新的梗阻6。
verumontanum 是男性生殖系统中至关重要的解剖元件，确保射精过程中精液的精确和有序排出，同时也有助于防止逆行流动。目前尚不清楚TURED的缺点是否可以通过保留痈来改善。一些研究试图利用激光辅助内窥镜治疗 EDO，同时保留 verumontanum 2,7,8,9。尽管手术方法各不相同，但术后精液恢复非常成功，并发症极少。这表明保留附睾头可能是有益的。然而，他们使用的方法相对复杂，不会干预健康的射精管，这可能会增加复发的风险。因此，我们提出了一种简单有效的手术方法。
在这项研究中，精囊镜通过导线器引导进入患侧的射精管囊肿。然后，使用钬激光扩大患侧射精管开口，以确保其具有足够大的流出通道。

<table><tbody><tr><td>Camera system</td><td>Karl Storz, Germany</td><td>TC200EN</td><td>Endoscopic camera system</td></tr><tr><td>Fr18 Cathete</td><td>Zhanjiang City Shida Industrial Co., Ltd.</td><td>2660476</td><td>Drainage of urine</td></tr><tr><td>Fr6/7.5 vesiculoscope</td><td>Richard Wolf, germany</td><td>8702.534</td><td>Operative procedure</td></tr><tr><td>iodophor</td><td>Shanghai Likang Disinfectant Hi-Tech Co., Ltd.</td><td>31005102</td><td>Skin disinfection</td></tr><tr><td>Nitinol Guidewire 0.035&quot;</td><td>C. R Bard, Inc. Covington, GA&amp;nbsp;</td><td>150NFS35</td><td>Guide</td></tr><tr><td>Propofol</td><td>Sichuan Kelun Pharmaceutical Research Institute Co., Ltd.</td><td>H20203571</td><td>Induction and maintenance of anesthesia</td></tr><tr><td>Remifentanil</td><td>Yichang Humanwell Pharmaceuticals CO,Ltd.</td><td>H20030200</td><td>Maintenance of anesthesia</td></tr><tr><td>Rocuronium bromide</td><td>Zhejiang Huahai&amp;nbsp; Pharmaceuticals CO,Ltd.</td><td>H20183264</td><td>Induction and maintenance of anesthesia</td></tr><tr><td>Sevoflurane</td><td>Jiangsu Hengrui Pharmaceuticals Co., Ltd.</td><td>H20070172</td><td>Maintenance of anesthesia</td></tr><tr><td>Slimline EZ 200</td><td>LUMENIS, USA</td><td>0642-393-01</td><td>Dissect capsule wall</td></tr><tr><td>Sodium Chloride Physiological Solution</td><td>Hua Ren MEDICAL TECHNOLOGY CO. Ltd.</td><td>H20034093</td><td>Flushing fluid</td></tr><tr><td>Sufentanil</td><td>Yichang Humanwell Pharmaceuticals CO,Ltd.</td><td>H20054171</td><td>Induction and maintenance of anesthesia</td></tr><tr><td>Syringe 50 mL&amp;nbsp;</td><td>Double Pigeon Group Co. Ltd.</td><td>20163141179</td><td>Inject 0.9% sodium chloride solution into the vesiculoscope</td></tr><tr><td>VersaPulse PowerSuite 100W Laser System</td><td>LUMENIS, Germany</td><td>PS.INT.100W</td><td>Provide energy</td></tr></tbody></table>

treatment of ejaculatory duct obstruction by seminal vesiculoscopy assisted flow modification

经尿道射精管切除术 （TURED） 是治疗射精管囊肿引起的射精管阻塞 （EDO） 的主要手术方法。通常需要术中切除verumontanum以暴露射精管。然而，保留verumontanum结构可以更好地模拟正常的生理解剖结构。维持藜膜可能会增加术后远端射精管瘢痕形成的风险，导致复发性梗阻或精液量减少。因此，我们尝试了一种保留verumontanum的新技术，与TURED相比，它相对更容易，更安全。以下是程序步骤:1.通过尿道外口将6F精囊镜引入verumontanum附近，定位患侧射精管的开口，并将导丝引入囊肿。这一成功的步骤保留了verumontanum，最大限度地保留了远端射精管中的抗反流机制。2.钬激光将患侧射精管开口扩大至5mm，降低术后射精管开口闭合的可能性，简化手术过程。3.在囊肿内创建一个窗口以进入对侧精囊，然后使用钬激光将开口燃烧并扩张至5毫米，将对侧射精管重定向到囊腔。这种修改保留了健康侧射精管的开口，并为精液提供了新的流出通道，降低了术后精液量减少的风险。患者术后无并发症，住院时间较短，精液量有所改善。因此，这种手术方法简单而有效。

本研究共纳入 5 名患者，年龄从 27 岁到 34 岁不等（中位数为 31 岁），病程为 6 至 15 个月（平均 9 个月）。随访时间为 12 至 48 个月（平均 24.8 个月）。所有患者均顺利完成手术。平均手术时间为26分钟，平均住院时间为2天。5例均出现单侧EDO和对侧精囊扩张。与患者有关的人口统计信息，包括术前和术后数据，如表1所示。精囊镜检查手术后 1 个月射精管的代表性图像已在补充图 1 中提供。
在我们的研究中，我们观察到 5 名患者因单侧射精管囊肿而导致射精管阻塞，手术期间在囊肿液中检测到精子。所有患者均在术后第 3个月进行术后随访和精液分析。将精液分析结果（包括射精量、射精pH值、精子计数和精浆果糖）与术前数据进行比较。如 表2所示，术后精液相关指标表现出显著改善，且这些差异具有统计学意义（P<0.05，使用配对t检验确定）。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/66146/66146fig01.jpg"> 图 1:射精囊肿的 MRI 扫描。 白色箭头表示射精管的囊肿。（A） 射精管囊肿的T2加权轴向横截面图像。（B） 射精管囊肿的T1加权轴向横截面图像。（三）射精管囊肿的 T2 加权轴向纵切面图像。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66146/66146fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/66146/66146fig02.jpg"> 图 2:关键手术步骤的屏幕截图。 （A） 在患侧找到藰膜和射精管开口。（二）导丝器刺穿射精管开口。（C）进入囊肿，找到受影响的精管。（D）钬激光切口扩大射精管开口。（E） 手动创建一个窗口，将健康侧的射精管流量重定向到囊肿腔。（F） 钬激光切口扩大了健康一侧的人工开口。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66146/66146fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>项目</td>
			<td></td>
		</tr><tr><td>平均年龄，年份</td>
			<td>30.4 (27-34)</td>
		</tr><tr><td>病程，月数</td>
			<td>9 (3-15)</td>
		</tr><tr><td>跟进时间，数月</td>
			<td>24.8 (12-48)</td>
		</tr><tr><td>操作时间，分钟</td>
			<td>26 (15-40)</td>
		</tr><tr><td>导尿时间，天</td>
			<td>1</td>
		</tr><tr><td>住院时间，天</td>
			<td>2</td>
		</tr></tbody></table>表1: 人口统计数据（包括术前和术后数据）。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>项目</td>
			<td>术前</td>
			<td>手术后</td>
			<td>P值</td>
		</tr><tr><td>体积 （mL）</td>
			<td>0.76 ± 0.24</td>
			<td>3.22 ± 0.84</td>
			<td>0.004</td>
		</tr><tr><td>酸碱度</td>
			<td>6.7 ± 0.27</td>
			<td>7.38 ± 0.13</td>
			<td>0.005</td>
		</tr><tr><td>精子浓度 （x106/mL）</td>
			<td>7.16 ± 1.87</td>
			<td>57.66 ± 31.53</td>
			<td>0.025</td>
		</tr><tr><td>精浆果糖（μmol/单次射精）</td>
			<td>6,18 ± 4.10</td>
			<td>29.55 ± 12.04</td>
			<td>0.01</td>
		</tr></tbody></table>表2: 精液分析数据。
补充图1:囊泡镜检查检查一个月后回顾。（A） 患侧的开放性射精管。 （B） 射精囊肿内的导管外侧开口。<a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/66146/Supplementary%20Figure.zip" target="_blank">请点击此处下载此文件。</a>

Watch this Scientific Journal Video about Advanced Treatment of Seminal Duct Blockage Employing Endoscopy-Mediated Semen Channel Refluviation at JoVE.com

作者聚焦: 采用内窥镜介导的精液通道再激流治疗精管阻塞的先进治疗 

本方案介绍了精囊内镜联合钬激光治疗射精管囊肿引起的射精管梗阻的临床应用。

精囊镜辅助血流调整治疗射精管梗阻

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory ...

本研究的范围主要是膀胱镜辅助精管分裂的临床效果。在治疗精管囊肿引起的精管梗阻。我们澄清说，该手术采用通道，这是一种非常有效的手术方法。目前的主要挑战是射精管囊肿引起的射精管阻塞的发生率非常低。并且很难积累足够的患者来与其他外科手术进行大量对照研究。与其他手术方法相比，该方法可以更好地保留的远端解剖结构。并且不太可能引起异常射精的并发症。润滑异常。而损失，阻塞的风险增加率较低。未来，我们将专注于改进内窥镜技术。更纤细、更清晰的内窥镜，用于精髓疾病的诊断和治疗。

treatment-ejaculatory-duct-obstruction-seminal-vesiculoscopy-assisted

Nanyang Technological University

Research

JoVE Journal

Medicine

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification

2.4K 次观看.  The Second Affiliated Hospital of Kunming Medical University. 本研究的范围主要是膀胱镜辅助精管分裂的临床效果。在治疗精管囊肿引起的精管梗阻。我们澄清说，该手术采用通道，这是一种非常有效的手术方法。目前的主要挑战是射精管囊肿引起的射精管阻塞的发生率非常低。并且很难积累足够的患者来与其他外科手术进行大量对照研究。与其他手术方法相比，该方法可以更好地保留的远端解剖结构。并且不太可能引起异...

视频: 作者聚焦: 采用内窥镜介导的精液通道再激流治疗精管阻塞的先进治疗 

Cannulation of the Mouse Submandibular Salivary Gland via the Wharton's Duct

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their head and neck regions for cancer treatment. Both groups of patients experience symptoms such as xerostomia (dry mouth), dysphagia 
(impaired chewing and swallowing), severe dental caries, altered taste, oro-pharyngeal infections (candidiasis), mucositis, pain and discomfort.
One innovative approach of regenerative medicine for the treatment of salivary gland hypo-function is speculated in RS Redman, E Mezey 
et al. 2009: stem cells can be directly deposited by cannulation into the gland as a potent method in reviving the functions of the impaired organ. Presumably, 
the migrated foreign stem cells will differentiate into glandular cells to function as part of the host salivary gland. Also, this cannulation technique is an 
expedient and effective delivery method for clinical gene transfer application.
Here we illustrate the steps involved in performing the cannulation procedure on the mouse submandibular salivary gland via the Wharton's duct 
(Fig 1). C3H mice (Charles River, Montreal, QC, Canada) are used for this experiment, which have been kept under clean conventional conditions at 
the McGill University animal resource center. All experiments have been approved by the University Animal Care Committee and were in accordance with the 
guidelines of the Canadian Council on Animal Care.
For this experiment, a trypan blue solution is infused into the gland through the opening of the Wharton's duct using a 
insulin syringe with a 29-gauge needle encased inside a polyethylene tube. Subsequently, the mouse is dissected to show that the infusions migrated 
into the gland successfully.

A protocol for the cannulation of the mouse submandibular salivary gland via the Wharton's duct is described. For this experiment, the trypan blue solution is used as a dyer to demonstrate how this technique effectively delivers infusions into the targeted gland, and to suggest the reliability of this new approach as a potential clinical drug/cell therapy for the regeneration of salivary glands.

沃顿商学院的导管插管通过小鼠颌下腺唾液腺

Severe salivary gland hypofunction is frequently found in patients with Sj&ouml;gren's syndrome and those who receiving therapeutic 
irradiation in their ...

科研

医学

Accuracy in Dental Medicine, A New Way to Measure Trueness and Precision

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base for dental restorations. The current limitation of many reference scanners is the lack of accuracy scanning large objects like full dental arches, or the limited possibility to assess detailed tooth surfaces. A new reference scanner, based on focus variation scanning technique, was evaluated with regards to highest local and general accuracy. A specific scanning protocol was tested to scan original tooth surface from dental impressions. Also, different model materials were verified. The results showed a high scanning accuracy of the reference scanner with a mean deviation of 5.3 &#177; 1.1 &#181;m for trueness and 1.6 &#177; 0.6 &#181;m for precision in case of full arch scans. Current dental impression methods showed much higher deviations (trueness: 20.4 &#177; 2.2 &#181;m, precision: 12.5 &#177; 2.5 &#181;m) than the internal scanning accuracy of the reference scanner. Smaller objects like single tooth surface can be scanned with an even higher accuracy, enabling the system to assess erosive and abrasive tooth surface loss. The reference scanner can be used to measure differences for a lot of dental research fields. The different magnification levels combined with a high local and general accuracy can be used to assess changes of single teeth or restorations up to full arch changes.

Accuracy is a major demand in dental medicine. To verify accuracy, reference scanners are needed. This article presents a new reference scanner with an adjusted scanning method to acquire a broad variety of dental morphologies with high trueness and precision.

精度在牙科医学，一种新的方法来测量正确度与精密度

Reference scanners are used in dental medicine to verify a lot of procedures. The main interest is to verify impression methods as they serve as a base ...

Bile Duct Ligation in Mice: Induction of Inflammatory Liver Injury and Fibrosis by Obstructive Cholestasis

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well as to excrete bilirubin and other metabolic products. In the liver, the experimental obstruction of the extrahepatic biliary system initiates a complex cascade of pathological events that leads to cholestasis and inflammation resulting in a strong fibrotic reaction originating from the periportal fields. Therefore, surgical ligation of the common bile duct has become the most commonly used model to induce obstructive cholestatic injury in rodents and to study the molecular and cellular events that underlie these pathophysiological mechanisms induced by inappropriate bile flow. In recent years, different surgical techniques have been described that either allow reconnection or reanastomosis after bile duct ligation (BDL), e.g., partial BDL, or other microsurgical methods for specific research questions. However, the most frequently used model is the complete obstruction of the common bile duct that induces a strong fibrotic response after 21 to 28 days. The mortality rate can be high due to infectious complications or technical inaccuracies. Here we provide a detailed surgical procedure for the BDL model in mice that induce a highly reproducible fibrotic response in accordance to the 3R rule for animal welfare postulated by Russel and Burch in 1959.

Disruption of bile flow results in severe inflammatory cholestatic liver injury with a characteristic time-dependent sequence of morphological alterations. Here we present a protocol for the surgical ligation of the common bile duct in mice that allows to induce a strong fibrotic response after 21 to 28 days.

胆管结扎小鼠:感应炎性肝损伤和纤维化的阻塞性胆汁淤积

In most vertebrates, the liver produces bile that is necessary to emulsify absorbed fats and enable the digestion of lipids in the small intestine as well ...

A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive nephropathy induced by unilateral ureteric obstruction (UUO), which can either be irreversible (UUO) or reversible (R-UUO). In the irreversible UUO model, the ureter may be obstructed for variable periods of time in order to induce increasingly severe renal inflammation and interstitial fibrotic scarring. In the reversible R-UUO model the ureter is obstructed to induce hydronephrosis, tubular dilation and inflammation. After a suitable period of time the ureteric obstruction is then surgically reversed by anastomosis of the severed previously obstructed ureter to the bladder in order to allow complete decompression of the kidney and restoration of urinary flow to the bladder. The irreversible UUO model has been used to investigate various aspects of renal inflammation and scarring including the pathogenesis of disease and the testing of potential anti-inflammatory or anti-fibrotic therapies. The more challenging model of R-UUO has been used by some investigators and does offer significant research potential as it allows the study of inflammatory and immune processes and tissue remodeling in an injured and scarred kidney following the removal of the injurious stimulus. As a result, the R-UUO model offers investigators the opportunity to explore the resolution of kidney inflammation together with key aspects of tissue repair. These experimental models are of relevance to human disease as patients often present with obstruction of the renal tract that requires decompression and are commonly left with significant residual kidney impairment that has no current treatment options and may lead to eventual end stage kidney failure.

The murine model of irreversible unilateral ureteric obstruction (UUO) is presented together with the model of reversible UUO in which the ureteric obstruction is relieved by anastomosis of the severed ureter into the bladder. These models enable the study of renal inflammation and scarring as well as tissue remodeling.

的不可逆和可逆单侧输尿管梗阻小鼠模型

Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive ...

Vessel-Sparing Microsurgical Longitudinal Intussusception Vasoepididymostomy to Treat Epididymal Obstructive Azoospermia

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of epididymal OA since 2000. There are two challenges in classic microscopic vasoepididymostomy. First, anastomosis of the vas deferens and epididymis is performed with double-needle sutures. However, there is a lack of good-quality and cost-effective double-needle sutures in China, which leads to increased difficulty and poor success rates of anastomosis. Second, the separation of the vas deferens does not retain vasculature, although the vas deferens vasculature plays an important role in the blood supply to the vas deferens, epididymis, and testis. This affects the blood supply to the anastomotic area and epididymis.
Therefore, this team has made innovative improvements to address these problems. Good-quality, cost-effective, single-needle sutures, which are easy to purchase in China and other countries, were used in microsurgical longitudinal intussusception vasoepididymostomy. This can optimize the operation procedure and shorten the operation time while ensuring the success rate of the anastomosis. The surgical method of preserving the vas deferens vessels was innovatively proposed because the etiology of epididymal OA is mostly inflammatory in China. The protection of the blood supply to the vas deferens and epididymis is maximized using microsurgical forceps to separate and protect the vasculature. Patency reached 81.7% in the postoperative follow-up, indicating a better surgical treatment effect.

The present protocol describes a vessel-sparing, longitudinal intussusception vasoepididymostomy using readily available single-needle sutures in China, a safe and effective procedure, which may improve patients' patency and natural pregnancy rates.

血管保留性显微外科纵向套叠血管表皮造口术治疗附睾梗阻性无精子症

The epididymis is a common site of obstruction in obstructive azoospermia (OA). Vasoepididymostomy has become an important method for the treatment of ...

A Modified Vessel-Sparing Microsurgical Vasoepididymostomy

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, preserving the vasal vessels during MVE might better simulate the normal physiological structure and be meaningful for patients who have undergone varicocelectomy. Nevertheless, preserving the vasal vessels might elevate the risk of increasing the tension of anastomosis, affecting the patency rate and leading to delayed postoperative bleeding. Therefore, we developed a novel vessel-sparing MVE to make it safer. Here is a summary of the improvements to the procedure. 1) The retrograde dissociation of the vasal vessels on the proximal testicular side was adopted as the main method, and the anterograde dissociation of the vasal vessels on the distal testicular side was adopted as a supplement to dissociate the vasal vessels to be preserved. This improvement ensures the blood supply to the vas deferens that will be used for anastomosis and also provides longer vasal vessels, which reduces the tension of anastomosis. 2) By fixing the vas deferens to be anastomosed and the broken end of the vas deferens, the free vasal vessels get fixed, which resolves the problem of transmission of vas tension to the vasal vessels and reduces the risk of vasal vessel hemorrhage. 3) Dissociation of the vas deferens after opening the tunica vaginalis increases the mobilization of the vas deferens, which also makes the new procedure easier to complete. The evaluation of the outcomes of this new procedure showed that no significant postoperative complications occurred in the patients, and the patency rate was no different from that of the conventional procedure. Therefore, this new, improved procedure can be considered safe, with satisfactory postoperative results.

Here, we present a protocol to preserve the vasal vessels in microsurgical vasoepididymostomy. The surgical security is enhanced by preserving the vasal vessels using a retrograde-anterograde dissociation and fixing the vasal vessels.

一种改良的血管保留显微外科血管附睾造口术

Microsurgical vasoepididymostomy (MVE) is the main surgical treatment for epididymal obstruction. The vasal vessels are ligated during MVE. However, ...

Clinical Application of 24 G Cannula Needle and 3-0 Polypropylene Suture in Vas Deferens Exploration

The goal of this article is to present the application of a 24 G cannula and 3-0 polypropylene suture as a simple method for the exploration of the vas deferens. During the exploration of the vas deferens, a 24 G cannula needle was used to puncture it. The fluid in the smear confirmed the presence of sperm, to determine whether or not there was concomitant obstruction at the junction of the epididymis and the vas deferens. Then, a 3-0 polypropylene suture (this suture specification has the advantages of a smooth surface, robust quality, and can be passed through a 24 G cannula needle) was passed through the cannula needle to probe the location of the obstructed site. With this technique, exploration of the vas deferens could be more targeted and accurate.

This protocol presents the clinical application of a 24 G cannula and 3-0 polypropylene suture as a simple and effective method for the exploration of the vas deferens.

24 g套管针和3-0聚丙烯缝合线在输精管勘探中的临床应用

The goal of this article is to present the application of a 24 G cannula and 3-0 polypropylene suture as a simple method for the exploration of the vas ...

Combination of High Ligation and Intraoperative Embolization using Polidocanol for Treatment of Varicoceles

Varicoceles are dilated veins within the pampiniform plexus and are relatively common in the general male population. The spermatic vein has many branches in the scrotal segment and then gradually merges into 1-2 trunks after passing through the internal inguinal ring. The key to a successful varicocelectomy is to ligate all the spermatic veins while protecting the testicular arteries and spermatic lymphatic vessels from damage. The small veins, including the branches of spermatic veins and collateral veins, are easily missed for ligation during conventional high ligation of varicocele, which has been suggested as a major cause of postoperative recurrence. Although microsurgery effectively reduces the risk of missing ligation of the spermatic veins during surgery, it has several shortcomings, such as long operation time and a steep learning curve. More importantly, this technique is difficult to carry out in primary hospitals due to the requirement of specialized equipment. Therefore, an attempt to modify the traditional high ligation aiming to reduce the postoperative recurrence rate has been carried out here. The protocol here combines traditional high ligation with intraoperative embolization to seal off the branches of the spermatic vein and collateral veins. We rapidly injected foamed sclerosant into the internal spermatic vein under direct observation after separation of the spermatic vein and then ligated all the veins. The foamed sclerosant through the varicose vein hampers endothelial cell growth, promotes the growth of thrombus and fibrosis, and ultimately forms fibrous streaks that permanently fill the venous. The results showed a more satisfactory effect on reducing the postoperative recurrence rate compared with traditional high ligation. Since this protocol is simple to carry out and has better results in reducing the recurrence rate, this can be an alternative surgical method for the treatment of varicocele, especially in primary hospitals.

<meta charset="utf8"></head><body>使用聚多卡醇的高位结扎和术中栓塞相结合治疗精索静脉曲张

To reduce the postoperative recurrence rate of varicocelectomy, we combined high ligation of varicocele with intraoperative embolization. We injected polidocanol from the spermatic vein during surgery to embolize the branches of the spermatic vein and collateral veins. This is an alternative surgical method for the treatment of varicocele.

使用聚多卡醇的高位结扎和术中栓塞相结合治疗精索静脉曲张

Varicoceles are dilated veins within the pampiniform plexus and are relatively common in the general male population. The spermatic vein has many branches ...

<meta charset="utf8"></head><body>男性双侧精索神经阻滞和输精管结扎术

Optimizing the Modified No-Scalpel Vasectomy Technique

No-scalpel vasectomy (NSV) is a commonly used contraceptive method for males. In previous applications of this surgical method, issues such as knot detachment and postoperative recanalization resulted in a reduced contraceptive success rate after vasectomy. This new technique innovatively modifies the ligation procedure during NSV to address knot detachment and postoperative recanalization. Two ligations of the testicular end of the vas deferens and one ligation of the abdominal end are completed before transection of the vas deferens. A fourth ligation of the abdominal end is performed using the suture tails of the third ligature of the testicular end after transection of the vas deferens. The fifth ligation of the abdominal end is performed using the suture tails of the first ligature of the testicular end. These modifications strengthen the ligations and reduce the postoperative recanalization rate. Additionally, the two stumps are gathered together, creating better conditions for a possible vasovasostomy in the future, thereby achieving overall better outcomes with vasectomy.

<meta charset="utf8"></head><body>优化改良的无手术刀输精管切除术技术

A modified no-scalpel vasectomy technique reduces the postoperative recanalization rate. This protocol describes a modified no-scalpel vasectomy technique that can reduce the postoperative recanalization rate.

优化改良的无手术刀输精管切除术技术

No-scalpel vasectomy (NSV) is a commonly used contraceptive method for males. In previous applications of this surgical method, issues such as knot ...

精囊镜辅助血流调整治疗射精管梗阻

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24 g套管针和3-0聚丙烯缝合线在输精管勘探中的临床应用

使用聚多卡醇的高位结扎和术中栓塞相结合治疗精索静脉曲张

使用聚多卡醇的高位结扎和术中栓塞相结合治疗精索静脉曲张

优化改良的无手术刀输精管切除术技术