Allogeneic Testicular Transplantation

Allogeneic testicular transplantation is an ideal method for the treatment of testicular abscess, bilateral small testicular or bilateral testicular severe atrophy caused by low blood testosterone. Thereby the patient is relieved of trauma and enhances confidence in life. However, postoperative spermatogenic function is not ideal. Once the rejection reaction occurs, acute or chronic rejection can lead to loss of spermatogenic function in the transplanted testicle. In 1978, Silber reported the success of the first testicular transplant between twins. In 1984, Wang Lingzhen reported that his father had a successful testicular transplant. In 1988, Zhan Bingyan reported on the experimental and clinical studies of the same kind of testicular transplantation in the American Journal of Transplantation Progress. According to statistics, about 50 cases of adult donor testicular allograft have been carried out in China. 85.3% of patients have improved sexual function after surgery, and 70% of patients have normal testosterone, but only 5.88% of them have fertility. Curing disease: Indication 1, congenital or traumatic testicular absent. 2, congenital testicular dysplasia or bilateral testicular severe atrophy with low blood testosterone. 3, bilateral abdominal cryptorchidism testicular fixation or autologous testicular transplantation testicular atrophy, necrosis. However, the above conditions can still maintain normal androgen levels, or the testis has normal endocrine function and only have no spermatogenic ability and require the restoration of spermatogenic function, which is not a surgical indication. Preoperative preparation 1, donor preoperative preparation 1 routine physical examination and hematuria routine, liver and kidney function, ECG, chest X-ray, blood type, intravenous pyelography and other auxiliary examination. 2 reproductive system examination: the exclusion of bilateral testicular, epididymis and vas deferens disease, if necessary, bilateral vas deferens to confirm the vas deferens. 3 routine examination of semen: the donor must have normal fertility, semen examination should be in the normal range, if it is better to have healthy children in the near future; 4 serum male hormone levels (including T, FSH and LH) are normal. 2, the recipient preoperative preparation 1 general examination: routine physical examination and hematuria routine, liver and kidney function, electrocardiogram, chest X-ray, blood type, intravenous pyelography and other auxiliary examination. 2 reproductive system examination: confirmed to be congenital testicular abscess or other causes of testicular abscess, bilateral testicular loss. No testicular disease can be judged by HCG test, testicular angiography, etc., if necessary, testicular exploration can be performed to confirm that there is no testicular disease. Non-functional testes must be examined for testicular histology. Patients with congenital testicular disease or other causes of testicular dysfunction, if long-term application of testosterone preparations, can have normal secondary sexual characteristics and normal libido and sexual function. In most congenital testicular patients, there may be vas deferens in the scrotum, and the residual vas deferens can be used as an anatomical tubule for the transplant of testes. 3 routine examination of semen: there is no sperm in the semen, but the semen volume and pH value are basically normal, and the fructose test is positive, indicating that the development and function of the prostate and seminal vesicle are normal. There is no sperm in the semen, and bilateral vas deferens obstruction should be excluded. If necessary, bilateral vas deferens should be performed. 4 serum male hormone levels: FSH and LH levels can be higher than normal, while T levels are lower than normal. 5 recipients in the developmental stage of puberty, due to the absence of testicles affect sexual development. At this time, long-acting testosterone should be applied to promote the development of secondary sexual characteristics and to obtain sexual function. 6 tissue matching for receptor HLA phase. 3, testicular lavage fluid preparation of 500ml, 20% mannitol 5ml, 25% magnesium sulfate 0, 36ml, heparin 100mg, adenosine 40mg, 10% glucose solution 20ml, pH 7, 5. Surgical procedure 1, take the testicular group (1) Incision: 1~2cm above the midpoint of the inguinal ligament as oblique incision parallel to the inguinal ligament, and then cut the skin, subcutaneous fat and fascia, and external oblique aponeurosis to protect the inguinal and inferior phrenic nerves. When the abdominal oblique muscles and transverse abdominis muscles were cut. (2) free spermatic vessels and vas deferens: incision of the cremaster muscle, free spermatic cord, vas deferens and testis, separating the spermatic veins and veins above the inner ring mouth, marked with silk thread. The spermatic vein, vein and vas deferens were cut off, and the proximal end was ligated separately. (3) Testicular lavage: Immediately remove the spermatic vessels, vas deferens and testes after the disconnection, and place them in a small pot containing 4 °C iced saline. The epidural catheter was carefully inserted into the lumen of the internal spermatic artery, and the testicular perfusion was performed at 4 ° C test pressure at 4 to 5 kPa (40 to 50 cm H 2 O) until the venous effluent was nearly clear. (4) Trimming the blood vessels: Under the operating microscope, carefully cut off the adventitia and the anterior membrane of the vascular end, trim the vascular end, and flush the vascular cavity with heparin isotonic saline. The testes, spermatic vessels, and vas deferens were then stored in a 4 ° C ice water container for later use. (5) Close the incision: suture the cremaster muscle, the internal oblique muscle, the external oblique muscle aponeurosis and the subcutaneous tissue and skin. 2, the transplant group (1) Incision: Take the oblique incision parallel to the inguinal canal, cut the anterior sheath of the rectus abdominis, retract the rectus abdominis muscle inward, reveal the inferior abdominal wall, veins, and free enough length. The distal end of the blood vessel is ligated, and the proximal end of the heart is clamped with a blood vessel clamp and then cut. The outer and anterior membranes of the vascular end were cut under a surgical microscope. Heparin isotonic saline flushes the lumen of the vessel. (2) free vas deferens: preserve the vas deferens artery, cut off the vas deferens at the inner ring, the distal end is reserved, and the proximal (scrotal) end is ligated. (3) Vascular anastomosis: Under the operating microscope, the internal and external veins of the donor's spermatic cord were respectively anastomosed to the lower end of the abdominal wall of the recipient with a 10-0 nylon thread. The vascular anastomosis method is the same as autologous transplantation of testes. (4) vas deferens anastomosis: vas deferens anastomosis vas deferens one layer anastomosis method and vas deferens two-layer anastomosis method. 7-0 nylon line intermittent anastomosis. (5) Separation of the scrotum: The deep fascia of the abdominal wall from the lower corner of the incision is separated from the scrotum by a finger, and a cavity sufficient to accommodate the testicle is separated between the skin and the meat membrane. (6) Fixing the testicles: Place the testicles in the outer space of the scrotal skin and fix them. Fix the anastomotic blood vessels to the surrounding tissue with two needles to avoid twisting and twisting of the blood vessels and affect the blood supply to the testicles. (7) Close the incision: suture the rectus abdominis anterior sheath, the external oblique muscle aponeurosis, subcutaneous tissue and skin. A rubber drain strip is placed inside the scrotum.