亚临床型右侧精索静脉曲张治疗临床意义研究

The clinical significance of treating right subclinical varicocele

目的探讨左侧精索静脉曲张合并亚临床型右侧精索静脉曲张患者同时行双侧精索内静脉高位结扎术的价值。方法左侧精索静脉曲张（Ⅱ～Ⅲ度）合并右侧亚临床型精索静脉曲张患者47例，随机分为A、B2组。A组（n=23）行左侧精索内静脉高位结扎术，B组（n=24）行双侧精索内静脉高位结扎术。全部患者手术前后均进行精液分析和彩色多普勒超声测量精索内静脉内径及双侧睾丸体积，并随访其配偶的妊娠情况1—2年。结果47例患者中，A组患者术后活动精子总数（TMSC）平均值较术前明显增加（P〈0．05），而B组术后较术前增加更加明显（P〈0．05）；A组患者右侧睾丸手术前后改变不明显（P〉0．05），而B组患者双侧睾丸术后与术前相比均有显著性差异（P〈0．05）。配偶妊娠情况随访：A组自然妊娠率为34.8％（8／23），B组为62．5％（15／24），B组与A组相比有明混差异（P〈0．05）。结论对于左侧精索静脉曲张（Ⅱ～Ⅲ度）合并右侧亚临床型精索静脉曲张患者，亚临床型精索静脉曲张对睾丸生精功能有损害，应同时进行双侧精索内静脉高位结扎术。

Objective To discuss the value of bilateral varicocelectomy in patients with left varicocele and right subclinical varicocele. Methyls 47 patients with grade Ⅱ - Ⅲ left varieocele and subclinical right varicocele were divided into groups A and B. In group A （ n = 23）, only left varicocelectomy was performed unilaterally; while in group B （ n = 24）, varieoelectomy was performed on both sides. Semen analysis was carried out with computer - aided sperm analyzer. The diameter of internal spermatic veins and the testicular volume were measured by color Doppler altrasonography. Follow- up was focused on semen analysis, testicular measurements and natural pregnancy data from the third month after the varicocelectomy. Results The average post- operative total motile sperm count （TMSC） increased significantly, when compared with the pre - operative ones （from 22.4 × 10^6 to 40.2 × 10^6 in group A, and from 23.2 × 10^6 to 60.8 × 10^6 in group B, P 〈 0.05）, with the increament greater in group B than in group A. Testicular volume increase was detected in the left testicle （ P 〈 0.05）, not in the right, in Group A; but in group B, both testes increased in size after the surgery （ P 〈 0.05）. Of the 47 patients＇ wives, the natural pregnancy rate was higher in group B than in group A（62.5 % vs 34.8 %, P 〈 0. 05）. Conclusion Right subclinical varicocele may have a detrimental effect on testis function, and bilateral varicocelectomy is advised on treating patients with grade Ⅱ - Ⅲ left varicocele and right subclinical varicocele.