精索静脉曲张手术前后精液超微结构研究

The study of semen ultrastructural changes after varicoceletomy in the patients with varicocele

目的研究精索静脉曲张患者手术前后精液超微结构的变化，评价精索静脉高位结扎术的效果及电镜的应用价值。方法36例精索静脉曲张患者均行精索静脉高位结扎术，取术前及术后半年精液分别行扫描电镜观察。10例正常供精者精液作为对照。结果精索静脉曲张时，患者精液主要参数（精子活动力，存活率）均明显下降，扫描电镜下，精子顶体缺失，线粒体鞘异常，尾部畸形；手术后，主要参数得到明显改善（P〈0．05），扫描电镜下，多数精子的顶体，线粒体鞘，尾部结构趋向正常。结论精索静脉高位结扎术后，精子畸形率降低，精液质量有所改善。扫描电镜在评价精子超微结构方面有一定优势。

Objective To study the semen ultrastructural changes before and after surgery in the patients with varicocele and evaluate the effectiveness of high ligation of internal spermatic vein and application value of electron microscopy. Methods The semen was analyzed and spermatozoa were investigated under scanning electron microscopy （SEM）in 16 patients before and after varicoceletomy and 10 normal volunteers. Results In varicocele patients, there was significant decreases in sperm motility, survival rate and sperm density. Under SEM,the deletion of the aerosome, the absence of segment of mitochondrial sheath and tail deformity were found. Half year after operation, the semen main parameters were significantly improved （ P〈 0. 05 ） , and in the great majority of sperm the acrosome,the segment of mitochondrial sheath and the tall structure turned toward to the normal under SEM. Conclusion The significant improvement of the semen quality and recovery of the sperm normal morphology and uhrastructure in patients could be achieved by successful varicoceletomy.