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Cirrhosis of the liver decreased sexual function is a relatively rare disease, hardening of the liver, but we should be more familiar with the syndrome, cirrhosis of the liver decreased sexual function is not so understanding, then please weakened liver syndrome male sexual therapist for us to be a specific introduction.
Great Wall Hospital, Nantong, an expert infertility treatment of male sexual function decreased liver syndrome expert, reduced male sexual function for liver cirrhosis syndrome, infertility Great Wall Hospital, Nantong, experts made the following explanation.
Male sexual function decreased liver syndrome, also known as endocrine lack - cirrhosis syndrome Silvestrini-corda syndrome. The main clinical features, on the basis of cirrhosis appear in the male breast development, testicular atrophy and decreased sexual function and other performance. The more common symptoms that men far outnumber women.
Inspection methods of the disease is to measure the serum E2, E3 increased the level of testosterone and its metabolites decreased. Appeared in the liver cirrhosis and other male breast development weakened the performance of gonads can make the diagnosis. Liver function because of decreased sexual function sclerosis syndrome manifested as cirrhosis of the liver on the basis of the gradual emergence of male breast enlargement, can also be unilateral bilateral to the right side is more common, mild nipple or areola when the nodules were shaped uplift, si


milar to female breast weight, may have pain, but no milk secretion. Another male testicular atrophy, sparse pubic hair, decreased libido, sound thinner, often with skin telangiectasia and liver caused by spider palm. Women with increased expression of estrogen often not obvious, may have menstrual disorders, amenorrhea, infertility and dysfunctional uterine bleeding.
Great Wall Hospital, Nantong, infertility experts said weakened male sexual function treatment of liver cirrhosis syndrome in many ways, the key is to select the patient's condition and disease mechanisms.
Steroids: also dominated the hormone replacement therapy, mainly for the endocrine treatment of erectile dysfunction, including primary and secondary hypothyroidism caused by gonadal erectile dysfunction.
Non-hormonal drugs: Hormone treatment of erectile dysfunction drugs, after all, a minority, non-hormonal drug therapy is still dominant. According to the site of drug action can be broadly divided into the following categories: adrenal receptor antagonists, dopamine type, 5 - hydroxytryptamine receptor antagonists.
Oral drugs: sildenafil (Viagra) is specific phosphodiesterase inhibitor, inhibited cGMP degradation, increased cGMP concentration, play a therapeutic effect of ED. There are headache, stuffy nose, facial flushing and other adverse reactions can be tolerated. Cardiac insufficiency due to those who take nitroglycerin disabled, poor cardiac function should be used with caution. March 1998 FDA approval of the market, in the United States have been prescribed more than 10 million copies, and swept the world.
Chinese medicine: Chinese medicine treatment of erectile dysfunction has a long history of traditional Chinese medicine dialectical therapy for erectile dysfunction treatment has some effect, the major mechanism is the aphrodisiac for therapeutic purposes, commonly used in Wu Zi Yan Zong Wan, Golden make up Kidney Pills, Male Bao, Yang Yang turtle tablets, capsules, etc. Deer Jing Pei Yuan.
In addition, Nantong Hospital Great Wall of infertility experts also pointed out that male sexual function decreased liver syndrome treatment methods and principles is a relatively simple, but we do not take it lightly, the slightest mistake will cause further hardening of liver function, or even cause liver cancer, so it is best to a regular hospital for specialist treatment.
October 28 is our
Over
Cholecystectomy syndrome (Postcholecystestomy Syndrome, PCS), also known as cholecystectomy complications, recurrent biliary syndrome (RecurrentBiliary Tract Syndrome), which is due after cholecystectomy and biliary lesions appeared on the clinical syndrome. After cholecystectomy is generally believed that about 25% to 30% may occur transient symptoms may disappear quickly, about 2% to 8% can be sustained because of symptoms, and need active treatment.According to history (gallbladder, bile duct or stomach, duodenum surgery), postoperative fever, abdominal pain and jaundice after taking into account that bile duct stones, bile duct stricture may be. B-mode ultrasound, CT, endoscopy, cholangiography can provide help in the diagnosis; ERCP or PTC and other tests, if necessary, with the fine needle aspiration needle (FNPTC) be satisfied with the diagnosis. Suspected sphincter of Oddi dysfunction who do stenosis or morphine - neostigmine provocation test. ERCP and FNPTC check for unknown reasons after small percentage of patients, diagnosis is difficult.PCS treatment designed to eliminate the cause, unobstructed biliary drainage, infection control. Simple "symptomatic treatment" often Debu to good results. Therefore, the treatment must be further explored its causes, to draw definitive diagnosis. Treatment of non-surgical and surgical treatment.
First, non-surgical therapy
1. Indications bile duct diameter <1cm, nor the lower bile duct stenosis. There is no obvious bile duct obstruction infection. acute or chronic cholecystitis, pancreatitis. bile duct ascariasis. biliary disorders. outside the biliary system diseases, such as hiatal hernia, peptic ulcer, chronic pancreatitis.
2. Treatment general therapy: including diet therapy, infusion, correcting water, electrolyte and acid-base balance. Chinese medicine: Chinese medicine, Chinese medicine dialectical theory of governance of the gallbladder, bile duct stones, biliary tract infection, pancreatitis, biliary ascariasis and other diseases has a good effect. Hypochondriac pain, pale, pulse string, liver qi stagnation were CHSGS Modified; hypochondriac pain, chills, fever, mouth and throat pain, jaundice, red tongue, yellow greasy moss, pulse a few are damp and slippery who Dachaihu Tang YCHT rule; hypochondriac pain, high fever, dry mouth, jaundice, yellow moss, pulse a few strings were applied to fire drug flaming Huanglianjiedu Tonga YCHT treatment. In addition, as with pancreatitis medication to Qingyitang (wood Lake, woody, Yuan Hu, white peony root, skullcap, rhubarb, Glauber's salt, etc.) based; as with roundworm may Jiawu Mei Tang rule. piercing: to relieve pain, regulate biliary function. Other: antibiotics, antispasmodic analgesic, antacids, H2-receptor blockers and so on.
Second, the surgical therapy
1. Indications large recurrent bile duct stones, intrahepatic bile duct stones, impacted stones in ampulla, bile duct stenosis and bile duct stones. recurrent bile duct biliary tract infection, obstructive suppurative cholangitis. Oddi sphincter stenosis, chronic pancreatitis with ampullary or pancreatic duct obstruction. left too long cystic duct to form a small gallbladder inflammation. drugs outside the biliary system is difficult to cure diseases, such as hiatal hernia, ulcer disease.
2. Surgical method according to pathological changes, decided surgery. left gall bladder or cystic duct is too long, should cholecystectomy or excision of cystic duct. CBD stones in common bile duct exploration should be performed to remove stones and biliary-enteric anastomosis or a variety of endoscopic sphincterotomy, lithotomy and so on. Oddi sphincter possible sphincterotomy stenosis angioplasty. common bile duct stenosis was feasible molding repair, or biliary tract reconstruction. Such as the common bile duct anastomosis, bile duct jejunum Roux-y anastomosis, Longmire surgery. biliary severe symptoms and diseases, such as hiatal hernia, ulcer disease, should also be given medicines or surgery.Cholecystectomy may be associated with this disease appears the following factors:
1. Intraoperative injury to the bile duct, gallbladder and extrahepatic bile ducts because there are large anatomical variation, or the inexperienced surgeon, may be injured during surgery of extrahepatic bile duct, causing postoperative bile duct stenosis, a small number of secondary the bile duct after bile duct damage caused by infection or obstruction cholangitis.
2.Oddi Vater sphincter stenosis and constrictive papillitis, after the reasons causing these pathological changes is unclear, and biliary stones may be muddy, especially bilirubin stones or chronic inflammation of local edema.
3. Postoperative bile salt metabolism and autonomic dysfunction, may affect bile excretion, Oddi sphincter tone and pressure of the common bile duct, the incidence of this disease may play a role.
There are several possible causes: Oddi sphincter dysfunction. About 2.4% of biliary problems after surgery, this disease is currently no good diagnostic method. preoperative misdiagnosis and treatment of diseases has been found, such as hiatal hernia, colon dysfunction, intestinal stress syndrome, peptic ulcer, etc., relying on the relevant test to confirm the diagnosis. many of the psychological factors that have without treatment.First, due to biliary disease
Cholecystectomy biliary disease omissions, such as extrahepatic or intrahepatic bile duct stones, Oddi sphincter narrow psychosis. In addition to cholecystectomy may also be caused by the surgery itself, such as the cystic duct left too long, traumatic bile duct stricture.
1. Bile duct stones after cholecystectomy syndrome is the most common cause. Can be divided into residual stones and recurrent stones, reported in the literature rate of 5% to 75% or even up to 87.8%.
(1) residual stones are not removed in surgery of the stone, can be divided into: to avoid residual stones: more a result of careful intraoperative exploration or unskilled is not due. difficult to avoid residual stones: intraoperative exploration found hepatolithiasis, confined to technical difficulties, difficult to remove. Or because an emergency case, does not allow detailed exploration or stone.
(2) recurrent stones have been removed in surgery, and later occurring stones, it is difficult to judge. Some people think that symptoms more than two years, could re-set stones.
2. Bile duct injury after injury, also known as biliary stricture stricture or bile duct stricture. More than 95% occurred in the cholecystectomy, the incidence is generally between 0.1% and 0.2%, from 100 to 200 cases per cholecystectomy bile duct injury occurs one case of stenosis. Injury of bile leakage, bile peritonitis, even if the union will continue to fibrosis and stenosis, biliary poor drainage, recurrent cholangitis. Stenosis, infection and recurrence of stones on each other, forming a vicious cycle.
3. Left too long cystic duct cystic duct after cholecystectomy who left more than 1cm long as the residue. A group of 132 cases of patients with biliary tract surgery in the X-ray analysis of the residual cystic duct imaging 20 cases, 15.2%. Lack of experience as surgeon, surgical acute inflammation, anatomical abnormalities, or gallbladder neck easily separated due to severe adhesion. Generally do not cause symptoms, but if there are stones in the cystic duct or bile duct obstruction in the lower end, the poor drainage of bile, intraluminal pressure increased, the expansion of the cystic duct and left secondary infection, the formation of a small gallbladder inflammation. The main symptoms are abdominal pain, fever, a small number of jaundice. Other symptoms include indigestion, anorexia, abdominal distension, nausea and vomiting. Cholecystectomy should pay attention to the treatment of cystic duct, common bile duct is generally believed that the expansion, no stones, common bile duct exploration were not from the common bile duct ligation 0.5cm cystic duct at the cut is more reasonable. Then the expansion of common bile duct, a stone, cut without opening the common bile duct stones in the gallbladder conventional exploration, ligation of common bile duct cystic duct as close as possible, as short as possible residual cystic duct, common bile duct injury that neither treatment and avoid left too long.
4. Biliary tract surgery dysfunction more common in young women, psychological factors, or endocrine disorders can be induced. Performance of paroxysmal abdominal pain, accompanied by abdominal distension, sweating, and rapid heart rate. But no symptoms of infection, X ray or B-no positive findings.
Sugawa ERCP examination by 73% gallbladder surgery syndrome had positive findings, 27% had no positive findings, mainly biliary disorders. Bar-meirs gallbladder surgery syndrome in 29 cases, 15 cases were found in 2 cases ERCP manometry (14%) papillary muscle dysfunction, bile duct pressure changes, Oddi sphincter spasm caused by common bile duct expansion. Tanaka that the pressure loss of bile duct after cholecystectomy buffer, directly affected by the sphincter. Sphincter contraction, cholecystectomy bile duct pressure were significantly increased. Bardley and Collins that cholecystectomy, serum cholecystokinin levels, can cause contraction of the sphincter Oddi, bile duct pressure rise to symptoms.
Second, and diseases caused by biliary
Some patients with symptoms aly exist before cholecystectomy, gallbladder disease mask the symptoms. Cholecystectomy with neglected diseases, such as hiatal hernia, ulcer, chronic pancreatitis, chronic hepatitis, cholecystectomy, gallbladder disease symptoms, symptoms of biliary disease from outside.In cholecystectomy, more than a few weeks or months after the onset of symptoms, mainly upper abdominal discomfort or pain in right hypochondrium, often has pain or pure pain, pressure, its nature is different from preoperative biliary colic may be associated with loss of appetite, nausea, abdominal distension, cramps and occasional bile duct was colic attack. Symptoms with the consumption of fatty foods in particular, into a certain relationship. Severe biliary tract infection can spupward, and chills high fever, jaundice.1. Biochemical white blood cell count, urine amylase, liver function, alanine aminotransferase, -GT peptide enzymes useful for the diagnosis of biliary obstruction.
2. Intravenous cholangiography poor developing intrahepatic bile duct, extrahepatic bile duct is also unclear, and a lot of influence by the liver so little diagnostic value.
3.B ultrasound can be found in bile duct dilatation, stones, bile duct cancer, pancreatitis. Simple, rapid diagnosis has some value, but there are limitations, can not display picture and all the symptoms of biliary system.
4. On the digestive tract angiography in the diagnosis of esophageal hiatal hernia, ulcer, duodenal diverticulum and so helpful.
5. Hepatobiliary CT scan in the diagnosis of liver cancer, intrahepatic bile duct dilatation, cholelithiasis, chronic pancreatitis.
6. Isotope 99m Tc-HDA hepatobiliary scanning, extrahepatic bile duct dilatation, gallstone disease and liver disease, gallbladder's function method is simple, no harm, for jaundice patients.
7. Endoscopy, including esophagoscopy, gastroscopy, duodenoscopy and so on.
ERCP after cholecystectomy syndrome the exact diagnosis, Hujia You and other reports 181 cases of ERCP, the diagnosis of biliary surgery syndrome discovery and experience. Found that the disease is as follows: to determine the cause of those 169 cases (93.4%), of which 159 cases of cholelithiasis (87.8%), biliary stricture 73 cases (40.3%), biliary tract dilatation in 106 cases (58.6%), chronic recurrent cholangitis 90 cases (49.7%). Unknown causes in 12 cases (6.6%). Diagnostic ERCP success rate was 83.3%, to directly and accurately and clearly show biliary disease picture, lesion shape, size, location and quantity.
8.PTC This method is suitable for imaging of biliary heavier direct identification of jaundice and bile duct lesions positioning.
9. Morphine - neostigmine provocation test. The methods are: intramuscular injection of morphine to patients 10mg, neostigmine 1mg, respectively, before injection, 1 hour after injection, 2 and 4 h of blood serum amylase and lipase measured tumor. Upper abdominal pain after injection, serum enzymes more than 3 times higher than normal for the positive.Most cholecystectomy syndrome can be prevented and can get an early cure.
1. Active in Chinese and western medicine biliary disease, have good indications for surgery, to minimize the acute biliary tract surgery, choose a good surgery.
2. Popularization of biliary imaging diagnostics, fully aware of biliary pathology. Cholangiography, biliary endoscopy, gall bladder pressure measurement and other help to improve treatment of biliary tract surgery.
3. Is a rare disease of intrahepatic bile duct, surgery is difficult, very important to improve skills in biliary tract surgery. Biliary tract surgery, such as to eliminate a variety of causes, prevention of bile duct stricture, and a patent drainage, biliary tract surgery syndrome will certainly reduce the chance.



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