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1.
Laparoscopic cryptorchidectomy in dogs --report of 15 cases   总被引:1,自引:0,他引:1  
The study aimed at determining the usability of laparoscopic cryptorchidectomy in treating cases of simple cryptorchidism and neoplastic testes in dogs. The presence of one or both testes inside the peritoneal cavity was confirmed in this study by an ultrasonographic examination employing the use of a 6.5 MHz convex head. The surgeries were conducted on a group of 15 dogs. In 12 subjects a one-sided cryptorchidism was found, 9 of which had right-sided cryptorchidism. In 3 dogs, both-sided cryptorchidism was observed. In 3 cases, an increase in the size of the abdominal testes with the symptoms of hyperestrogenism and feminisation raised a suspicion of neoplastic changes (SCT) taking place, which was confirmed by a histopathological examination. A laparoscopic cryptorchidectomy with intracorporal ligation was performed in all the subjects. The spermatic cord and ductus deferens were occluded with a ligature of an absorbable material, and a manually applied knot.  相似文献   

2.
REASONS FOR PERFORMING STUDY: Intra-abdominal ligation/ transection of the spermatic cord may result in necrosis of the testis; castration of abdominal cryptorchids via laparoscopy has therefore become common. Notwithstanding some adaptations of the technique, a small percentage of operations fail, prompting research into the anatomical background and clinical relevance of the procedure. HYPOTHESIS: That an alternate blood supply may prevent complete necrosis of the testis after spermatic cord transection. OBJECTIVE: To establish the prevalence of the problem in normal and cryptorchid stallions. METHODS: In a preliminary study, the spermatic cords of 8 normal stallions were ligated and transected at different sites and in various manners. Five weeks later the testes were removed and the vitality of both the testes and epididymes was evaluated. In a prospective clinical trial, intra-abdominal spermatic cord transection was performed in 241 cryptorchid and normal stallions. In cases of surgical failure, the testes were removed and histology performed. RESULTS: Examination of the specimen removed from the 8 animals of the preliminary study revealed that all epididymes were completely or largely spared. All except one testis were completely necrotic. In the patients that underwent surgery all abdominally retained testes (n = 123) were necrotic, while 5 out of 88 inguinally retained and 8 out of 236 normally descended testes had partially survived. The pattern of survival differed between inguinally retained and normally descended testes. The epididymes of these 13 horses were (largely) vital. The (partial) survival of the epididymes and inguinally retained testes was ascribed to an alternate blood supply via anastomosing vessels derived from the cremasteric artery. A tributary from the external pudendal artery was considered responsible for the partial survival of normally descended testes. CONCLUSIONS AND POTENTIAL RELEVANCE: After intra-abdominal transection of the entire spermatic cord, 5.6% of inguinally retained and 3.4% of normally descended testes failed to become completely necrotic, as a result of an alternate blood supply via the cremasteric and/or external pudendal artery. Therefore, laparoscopic castration without orchidectomy cannot be recommended as a trustworthy method for castration of inguinal cryptorchids and normal stallions.  相似文献   

3.
The location of an undescended testicle influences the choice of surgical technique for efficient cryptorchid castration. We review a standardized protocol for preoperative examination to dictate surgical approach to cryptorchidism. Cases are split into two periods: 2004–2006 and 2007–2014. In 2004–2006, conventional cryptorchidectomy and laparoscopic cryptorchid castration (standing) were both offered, but the choice of technique was based primarily on owners' preference for a recumbent or standing procedure. In 2007–2014, ultrasonography was used to locate the testes and dictate the preferred surgical approach; for abdominal testes, laparoscopic intraabdominal spermatic cord ligation without orchidectomy was preferred and for inguinal testes, conventional open orchidectomy. The numbers of animals requiring a second procedure to complete castration were compared between the two periods. In addition, failure rates for individual testes grouped by location were determined separately for the different techniques, and the value of preoperative ultrasonography to locate the retained testes was assessed. In 2004–2006, 15.3% (20/131) of the cryptorchids needed more than one surgery to complete castration, compared to 0.7% (1/144) in 2007–2014. Failure rates for laparoscopic castration were 0/168 (0%) for abdominal, 3/40 (7.5%) for inguinal, and 9/55 (16.4%) for scrotal testes; for conventional castration, failure was recorded for 3/12 (25%) abdominal and 0/92 (0%) inguinal testes. For 94% (156/166) of retained testes, ultrasound-based preoperative advice on surgical approach was correct. Using a standardized preoperative examination to determine choice of surgical technique significantly (P < .001) reduced the number of second surgeries needed to complete castration. Preoperative ultrasound is therefore a useful aid to determining the surgical approach to cryptorchid castration.  相似文献   

4.
In the present series of cases, 8 laparoscopic cryptorchidectomies and 4 laparoscopic ovariectomies were carried out in sedated standing horses. Sedation involved a lesser anaesthesiological risk than does general anaesthesia. As compared to laparotomic exposure, the minimally invasive laparoscopic intervention provided better visualisation, shorter operative time and faster recovery. The blood vessels supplying the testes and ovaries and the suspensory ligaments of the organs were sealed and cut with EnSeal?, an adaptive bipolar electrosurgical blood vessel- and tissue-sealing device. The clinical use of the blood vessel- and tissue-sealing device proved to be successful in all cases. Gradual separation of the intact tissue from the treated, compacted, dehydrated and homogenised tissue areas and occlusion of the lumen of blood vessels treated with the device could be observed in all histological sections. To the best of our knowledge, this is the first report on the use of EnSeal? for laparoscopic cryptorchidectomy and ovariectomy in horses.  相似文献   

5.
Standing laparoscopic removal of abdominally retained cryptorchid testes may reduce patient morbidity and speed recovery compared with traditional laparotomy because anaesthesia is avoided and skin incisions are smaller. Reliably locating the testis preoperatively is therefore optimal to avoid unnecessary surgical morbidity and expense. We describe and review the results of a simple method of location using ultrasound scanning of the inguinal region, with a negative result indicating abdominal retention. One hundred and twenty‐seven horses with 141 cryptorchid testes were identified. Eighty‐five testes were identified inguinally: 56 abdominal. Two inguinally retained testes were not observed on ultrasound (false negatives) and 2 testes were considered inguinal but subsequently had to be removed from the abdomen (false positives). Sensitivity of inguinal ultrasound to predict the location of cryptorchid testes was therefore 98% and specificity 97%. The technique described herein proved a reliable technique to locate cryptorchid testes prior to surgery, minimising morbidity and cost. Suspect cryptorchids with no external evidence of testes should undergo a screening blood test prior to this ultrasound method of diagnosis.  相似文献   

6.
Laparoscopic Cryptorchid Castration in Standing Horses   总被引:1,自引:0,他引:1  
Objective — This article describes a new technique for laparoscopic cryptorchid castration in standing horses. Study Design — Prospective study. Animals or Sample Population — Eight horses aged 11 months to 3 years and weighing between 300 and 643 kg. Methods — Food was withheld for 24 to 36 hours, and then horses were sedated with detomidine HC1 (0.02 to 0.03 mg/kg) and butorphanol tartrate (0.02 mg/kg). The paralumbar fossa region was desensitized with 2% mepivacaine in an inverted “L” pattern and caudal epidural anesthesia was administered with either xylazine (0.18 mg/kg diluted to 10 to 15 mL with 0.9% sodium chloride) or a combination of 2% mepivacaine and xylazine (0.18 mg/kg). Initial laparoscopic exploration was performed from the left flank; in three horses, right flank laparoscopy was needed to complete the procedure. The spermatic cord was ligated within the abdomen with one or two sutures of 0 polydioxanone suture, and the testis or testes removed through a flank incision. Results — In five horses with no palpably descended testes, standing laparoscopy was the only procedure performed, whereas in two horses, the abdominal testis was removed laparoscopically, and the descended testis was removed under short acting anesthesia. In one horse, with nonpalpable testes, it was determined by laparoscopic observation that the testes were in the inguinal canal, and castration was performed under general anesthesia. No surgical or postoperative complications were noted. The right side of the abdomen, and especially the right vaginal ring, could be easily observed from the left side by passing the laparoscope through a small perforation in the mesocolon of the descending colon or by elevating the descending colon with an instrument or by use of an arm in the rectum. Conclusions — The standing laparoscopic approach combined with or without short-acting anesthesia to remove the descended testis is easily performed. Clinical Relevance — This approach will provide surgeons with another option to castrate cryptorchid stallions.  相似文献   

7.
Plasma testosterone and oestradiol concentrations were measured in peripheral and spermatic venous blood of 13 dogs with unilateral inguinal cryptorchidism, 9 dogs with unilateral abdominal cryptorchidism, and in a control group of 36 mature normal dogs. The hormone concentrations were similar in the three groups, both in the peripheral and in the spermatic venous blood. The weight of the testes in the control group was correlated with the body weight and there was no significant difference between the weight of the right and the left testes. The weight of the abdominal testes was lower than that of the inguinal testes, and there was no compensatory enlargement of the contralateral scrotal testis. The cryptorchid testes showed little or no histological evidence of spermatogenesis, and spermatogenesis was usually normal in the scrotal testes.  相似文献   

8.
Objective — The purpose of this study was to determine the feasibility of using laparoscopy to remove cryptorchid testes from standing horses.
Study Design — Prospective clinical study.
Animals or Sample Population — Eleven client-owned horses ranging in age from 4 months to 2 years.
Methods — Abdominal insufflation was initiated and maintained using a 20 F insufflation tube, attached via a stopcock, to the low pressure regulator on a standard carbon dioxide pressure tank. After trocar and laparoscope placement in the ipsilateral flank the testes were identified. Local anesthesia of the structures to be manipulated was administered through the instrument channel on the operative laparoscope, using a catheter with a needle attached. Testes were grasped with large laparoscopic forceps and exteriorized through the abdominal wall. Ligation and transection of the mesorchium was extracorporeal. The descended testes were removed using a standard standing technique.
Results — Complications were minor, including mild colic in one horse. The mean surgical time for standing laparoscopic cryptorchidectomy and castration of these colts was 58.9 ±24.3 minutes.
Conclusions and Clinical Relevance — Standing laparoscopic cryptorchidectomy, using the instrumentation described, is a safe and practical technique in young horses.  相似文献   

9.
The surgical success of laparoscopic castration without orchidectomy results from avascular necrosis of the testes. However, failures and subsequent production of testosterone and stallion‐like behaviour have been previously identified. Laparoscopic castration without removal of the testes was performed in 32 horses with 2 normal descended scrotal testes between July 2006 and October 2012. The objectives of our study were to evaluate the success rate of laparoscopic castration without orchidectomy on descended testes in our population and assess complications and recovery time. Endocrine tests were performed after surgery and owners also asked to report on their horse's behaviour and ability to resume exercise. Castration was deemed successful if endocrine test results were in accordance with gelding values. Failed horses were castrated using a conventional technique and histology performed when possible. Basal testosterone levels decreased below 3 nmol/l after surgery in 30/32 cases. However, in 2 horses, stallion behaviour persisted and histological evaluation after inguinal castration showed residual viable tissue. Two horses maintained high testosterone levels after surgery associated with stallion‐like behaviour. Based on these results, 12.5% of horses (4/32 horses) failed to be considered a gelding based on either endocrine tests and/or histology. All horses, with one exception, were able to resume exercise less than a week after the procedure. Laparoscopic castration without orchidectomy appears to be a safe procedure. When assessing the success of laparoscopic castration, our total failure rate was 12.5% (4/32 horses) which is significantly higher than previously reported.  相似文献   

10.
Laparoscopic Repair of Scrotal Hernia in Two Foals   总被引:1,自引:0,他引:1  
Nonstrangulating indirect scrotal hernias were corrected in two 4-week-old Percheron foals by a laparoscopic technique. After laparoscopic reduction of herniated nonstrangulated small intestine each testes was retracted through the vaginal ring. The ligament of the tail of the epididymis was transected by electrocautery. The testicular vessels and nerves were isolated by cautery of the mesenteric portion of the mesorchium and then ligated. Staples were used to close the opening of the inguinal canal by apposing the peritoneal edges of the vaginal ring. Resection of umbilical stalk remnants via celiotomy performed in one foal after laparoscopic observation of enlargement of the right umbilical artery and urachus. No complications or recurrence of herniation had occurred 16 weeks after surgery.  相似文献   

11.
Cryptorchism is an inherited congenital abnormality characterized by the failure of one or both testes to descend into the scrotum. Diagnosis can be difficult if the retained testicular tissue cannot be localized during clinical examination and the history of the animal is unknown, or if the animal shows persistent male behaviour despite the history of successful previous castration. The present case report describes the history of a cryptorchid Lama and the techniques of general anesthesia and laparoscopic cryptorchidectomy advocated.  相似文献   

12.
Laparoscopic sterilization of Sardinia donkeys using an endoscopic stapler   总被引:1,自引:0,他引:1  
OBJECTIVE: To describe a laparoscopic technique for sterilization of the male donkey using an endoscopic linear stapler (ELS). STUDY DESIGN: Clinical report. ANIMALS: Male Sardinia donkeys (n=6), aged 24-36 months. METHODS: Laparoscopic sterilization was performed under standing sedation or recumbent under general anesthesia. An endoscopic linear stapler was used to transect, and control hemorrhage of, the spermatic cord. Serum testosterone concentrations were measured preoperatively and at 3, 6, and 12 months after sterilization. One testis from each of 2 donkeys was collected at 12 months for histologic examination. RESULTS: Sterilization was successfully achieved. The only minor intraoperative complication experienced was hemorrhage from 1 spermatic cord stump, which was re-stapled. No other major short- or long-term complications occurred. Serum testosterone concentrations were < 15 ng/dL at 3, 6, and 12 months after surgery in all donkeys. Testicular atrophy without evidence of revascularization was observed in the 2 testes examined histologically. CONCLUSIONS: Sterilization of descended testes by intraabdominal laparoscopic transection of the spermatic cord is a simple practical method, with minimal intraoperative or postoperative complications. Testicular revascularization did not occur. CLINICAL RELEVANCE: Laparoscopic sterilization in donkey can be performed using an endoscopic linear stapler as an alternative to scrotal castration.  相似文献   

13.
Radiolabeled testosterone (3H-T) was infused into the testes or left and right mesofuniculus (106 dpm) or injected into a testes (2 x 10(6) dpm). The 3H-T concentration was estimated 15 or 10 min after 3H-T infusion or injection, respectively, in the tissue samples collected from the prostate, seminal vesicles, caput and cauda epididymides, vasa deferentia and the mesofuniculi. The abdominal aorta and posterior vena cava were cannulated, and the posterior part of the body perfused with blood (at blood pressure 70-140 or 260-300 mm Hg in abdominal aorta) was used to study 3H-T transfer from the testes to venous blood and other male genital organs. The concentration of 3H-T found in the accessory genital glands, epididymes and vasa deferentia was affected by blood pressure in the abdominal aorta. The reduced blood pressure and partial blocking of blood supply to the genital organs (after ligation of both testicular arteries or the terminal part of the abdominal aorta) increased the concentration of 3H-T in accessory genital glands, vasa deferentia and epididymes. The removal of the mesofuniculi and vasa deferentia with their mesoducti reduced 3H-T concentration in the prostate, seminal vesicles and cauda epididymides. Both arterial trunks, testicular arteries and common iliac arteries, were shown to be connected by anastomoses in target organs so effectively, that supplying the male genital organs with blood by only one of them assures the transfer of testosterone from the testes to the epididymes, vasa deferentia, mesofuniculi as well as prostate and seminal vesicles. It was concluded that lymphatic vessels of the mesofunicules and of the spermatic cords as well as venous and arterial vasculature of the mesofunicules create a recently unknown pathway for the increase of testosterone supply from the testes to the epididymes, vasa deferentia and accessory genital glands of rats.  相似文献   

14.
The proportions of Sertoli cell tumor (SCT), seminoma and Leydig cell tumor in 50 dogs with unilateral testicular tumors were 52%, 36% and 12%, respectively. The rate of occurrence of SCT in the cryptorchid testis was very high (71%). The testicular superoxide dismutase (SOD) activity, testicular heat shock protein (HSP) 70 concentration and peripheral blood plasma inhibin (INH)-alpha concentration of 10 dogs with a unilateral cryptorchid testis and no testicular tumors, 10 dogs with SCT in a unilateral cryptorchid testis and 10 normal dogs, all aged 5-15 years, were measured in order to identify high risk factors for the occurrence of SCT in the canine cryptorchid testis. The mean SOD activity in cryptorchid testes and SCTs was significantly lower and higher, respectively, than in normal testes (both P<0.01). The mean HSP 70 concentration in both cryptorchid testes and SCTs was significantly higher than in normal testes (both P<0.01). The mean plasma INH-alpha concentration of the cryptorchid and SCT dogs was significantly lower and higher, respectively, than in normal dogs (P<0.05 and 0.01, respectively). The low SOD activity in the cryptorchid testis, low blood plasma INH-alpha concentration of the cryptorchid dogs and high HSP 70 concentration in the SCTs may be related to the occurrence of SCT and tumor cell proliferation in canine cryptorchid testes.  相似文献   

15.
OBJECTIVE: To describe a technique for laparoscopic cryptorchidectomy in standing horses using electrosurgical instrumentation. STUDY DESIGN: Retrospective clinical study. ANIMALS OR SAMPLE POPULATION: Ten horses, 1 to 7 years of age, with unilaterally or bilaterally retained testes. METHODS: Food was withheld for a minimum of 12 to 24 hours. Horses were sedated using xylazine hydrochloride (0.5 to 1 mg/kg) and butorphanol tartrate (0.02 mg/kg) or detomidine hydrochloride (0.02 to 0.03 mg/kg) and restrained in standing stocks. Three portal sites in the paralumbar fossae were locally desensitized using 2% mepivacaine. After trocar and laparoscope insertion, the ipsilateral testicle, mesorchium, and ductus deferens were identified. The cranial mesorchium was coagulated with either monopolar (one horse) or bipolar (nine horses) electrosurgical forceps, and then the mesorchium, ductus deferens, and ligament of the tail of the epididymis were transected from cranial to caudal using laparoscopic scissors. Once the testis was freed, the transected mesorchium was inspected for hemorrhage and the testis was removed by connecting the two instrument portals (eight horses). In two horses, the testis was placed within a laparoscopic retrieval bag and then removed without enlarging the portal incision. If the testes were retained bilaterally, the retained contralateral testis was removed similarly through the opposite paralumbar fossa. If the contralateral testis was descended, it was removed by a standard, standing castration technique. RESULTS: Vessels of the mesorchium were adequately coagulated using bipolar and monopolar electrosurgical forceps. No immediate or short-term complications occurred in 10 horses at 3 to 11 months after surgery. CONCLUSION: Standing laparoscopic cryptorchidectomy can be performed easily and safely using electrosurgical instrumentation as the sole means of providing hemostasis of the equine mesorchium. CLINICAL RELEVANCE: Standing laparoscopic cryptorchidectomy using electrosurgical instrumentation provides a safe, reliable, and efficient alternative to achieve hemostasis of the equine mesorchium.  相似文献   

16.
Ventral Abdominal Approach for Laparoscopic Cryptorchidectomy in Horses   总被引:1,自引:0,他引:1  
Objective —To report a ventral abdominal approach and a ligating loop technique for laparoscopic cryptorchidectomy in horses.
Study Design —Prospective.
Sample Population—Six horses, aged 1 to 5 years, with retained testes.
Methods —One laparoscopic portal and three to four instrument portals were used for ventral abdominal laparoscopic cryptorchidectomy. Laparoscopic instruments were used to maneuver and secure the testis through a ligating loop (modified Roeder knot) that was secured from outside the abdominal cavity. Only minimal enlargement of one instrument portal was used to remove the testicle.
Results —Three horses were bilateral cryptorchids, and three were unilateral (left side, two; right side, one) cryptorchids. Operative time, defined as the time from laparoscope insertion to removal, ranged from 20 to 25 minutes for unilateral cryptorchids and from 40 to 50 minutes for bilateral cryptorchids.
Conclusions —The reported technique allowed decreased tension on the tissues during ligation and removal of the testis from the peritoneal cavity. Improved observation of the abdominal cavity, ligation security, shortened patient confinement time, and minimally invasive technique are all considered to be benefits of laparoscopic cryptorchidectomy.
Clinical Relevance —Direct observation of retained testes and intraabdominal castration are distinct advantages of the use of laparoscopy in horses that have had previous unsuccessful surgical attempts, horses with unknown histories that have retained testicular tissue, or bilateral abdominal cryptorchids.  相似文献   

17.
Laparoscopic cryptorchidectomy without insufflation was applied in 10 standing bulls aged 3 to 15 months. Nine bulls were preoperatively pointed out intra-abdominal testes by computed tomography. Preoperative fasting for a minimum of 24 hr provided laparoscopic visualization of intra-abdominal area from the kidney to the inguinal region. Surgical procedure was interrupted by intra-abdominal fat and testis size. It took 0.6 to 1.5 hr in 4 animals weighing 98 to 139 kg, 0.8 to 2.8 hr in 4 animals weighing 170 to 187 kg, and 3 and 4 hr in 2 animals weighing 244 and 300 kg to complete the cryptorchidectomy. In conclusion, standing gasless laparoscopic cryptorchidectomy seems to be most suitable for bulls weighing from 100 to 180 kg.  相似文献   

18.
Colour-coded duplex sonography was used to examine the testes of 42 dogs whose testes were normal on clinical examination. With colour Doppler, the blood flow in the supratesticular region could be displayed clearly in 70 per cent of the cases, independent of the dog's age, bodyweight, pulse rate and the volume of its testes. The marginal artery could be displayed clearly in 56 per cent of the cases, and the clarity was correlated with bodyweight (P<0.001), testicular volume (P<0.001), and pulse rate (P<0.001). The intratesticular blood flow could not be discerned in 42 per cent of the cases. With pulsed Doppler, the mean resistive index (RI) in the supratesticular region was 0.57, and the mean pulsatility index (PI) was 1.00. In the marginal artery, the mean RI was 0.49, and mean PI was 0.78. In the intratesticular arteries, the mean RI was 0.47, and the mean PI was 0.75. At all three sites both indices were independent of age, bodyweight, pulse rate and testicular volume.  相似文献   

19.
The effects of a cryptorchid testis on the contralateral testis were investigated after artificially producing unilateral cryptorchidism in 8 beagle dogs. Bilateral testicular biopsy and collection of spermatic vein blood and peripheral vein blood were performed at the time of the operation to produce the cryptorchidism and 52 weeks later. The testicular tissue was used for histological examination by light microscopy and measurement of the testicular transferrin (Tf) concentration by enzyme immunoassay. Plasma testosterone (T), estradiol-17 beta (E2), and luteinizing hormone (LH) levels were measured by radioimmunoassay. Semen was collected weekly and its quality was examined. No spermatogenesis was observed in the cryptorchid testes at 52 weeks after the operation, and the number of germ cells in the contralateral testes had decreased but the number of Sertoli cells did not change. The Tf concentration in both testes had also decreased. The mean total number of sperm between 48 and 52 weeks after the operation (194 x 10(6)) was less than half the number before the operation (510 x 10(6)). Mean spermatic vein plasma T levels (51 ng/ml) in the cryptorchid testes 52 weeks after the cryptorchid operation were significantly lower than before the operation (91 ng/ml; P < 0.05). By contrast, spermatic vein plasma E2 levels (80 pg/ml) were significantly higher than the values before the operation (51 pg/ml P < 0.05). The peripheral plasma LH levels decreased. These findings indicate that a large quantity of E2 secreted by the cryptorchid testis inhibits the endocrine and spermatogenic functions of the contralateral testis in the dog. In particular, it is assumed that dysfunction of the contralateral testis is associated with Sertoli cell dysfunction suggested by the low Tf concentration.  相似文献   

20.
Objective: To describe laparoscopic‐assisted colopexy and sterilization, and evaluate outcome and effects in healthy male dogs. Study Design: Experimental study. Animals: Male Beagle dogs (n=7). Methods: A laparoscopic‐assisted, extracorporeally sutured colopexy, and sterilization by ligation and section of the testicular vessels and ductus deferens were evaluated 11 weeks after surgery. Ex vivo tensile tests were performed on the colopexy sites and loss of testicular function was assessed by monitoring serum testosterone, and by ultrasonographic and histologic examinations of the testes. Systemic inflammation and potential iatrogenic colonic functional disorders were investigated by monitoring serum C‐reactive protein (CRP) in the perioperative period and from a sulfapyridine (SP) kinetic profile obtained before and 10 weeks after surgery. Results: No intraoperative complications were recorded and clinical outcome was considered fair in all dogs. A mean tensile force of 42 N was required to disrupt colopexies. No relevant postoperative increase in CRP concentrations or changes in SP kinetics were observed. Testicular function was lost. Conclusions: Laparoscopic‐assisted colopexy achieved adhesion of the colon to the abdominal wall and testicular endocrine function and spermatogenesis were eliminated by laparoscopic castration.  相似文献   

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