输精管吻合术后男性生育力的临床观察

Clinical observation on male fertility after vasectomy reversal

目的观察输精管吻合术后男性的生育力恢复情况。方法对158例男性成功复通患者进行前瞻性队列研究，观测术后1、6、12、24个月的精液参数变化和随访配偶妊娠情况。对复通后生育组与未生育组之间的相关影响因素进行比较，并采用Logistic回归分析法进行相关性分析。结果158例复通者在术后1、6、12、24月后的精子密度的均值分别为：（10．1±1．3）106／ml、（13．3±1．5）106／ml、（20．6±7．1）106／ml、（19．4±3．1）106／ml，前向运动精子百分率的均值分别为：（21．3±6．5）％、（34．2±6．9）％、（53．1±8．6）％和（45．9±12．1）％，精子正常形态百分率（％）的均值分别为：（10．7±2．1）％、（16．2±4．5）％、（28．5±5．5）％和（25．7±7．2）％。其中有81例（51．3％）在术后12个月的精子密度、前向运动精子百分率、精子正常形态百分率的均值达正常参考范围。复通后24个月内配偶总妊娠率为65．9％（105／158），术后6、12、24个月各精液参数值与1月比较，P〈0．01。Logistic回归分析结果表明，配偶受孕与精子正常形态百分率呈正相关（r=0．189，P=0．000），和配偶年龄呈负相关（r=0．171，P=0．004），与其他因素无关。结论输精管吻合术后男性精液质量随时间变化而改善，1年后超过一半复通者的精子密度、前向运动精子百分率、精子正常形态百分率可达到正常参考范围。配偶受孕率随着精子正常形态百分率的增加而增加，随着配偶年龄的增加而降低。

Objective To investigate the recovery of male fertility after Vasectomy reversal. Methods The prospective cohort study was applied in 158 male patients after successful recanalization. The changes of semen parameters at months 1, 6, 12 and 24 after the reversal and the pregnancy rate of their spouses were examined. The correlation factors between the fertility and the infertility groups were comparatively analyzed by using logistic regression analysis. Results After recanalization, the average sperm densities （106/ml） of 158 patients at months 1, 6, 12 and 24 were 10.1±1.3, 13.3±1.5, 20.6±7.1 and 19.4±3.1 respectively; The average percentages （%） of the progressive sperm motility were 21.3±6.5, 34.2±6.9, 53.1±8.6 and 45.9±12.1 respectively.The average percentages （%） of the normal sperm morphology were 10.7~2.1, 16.2 ±4.5, 28.5=1=5.5 and 25.7±7.2 respectively. The sperm densities, the percentages of progressive sperm motility and the percentages of normal sperm morphology of 81 cases （51%） reached the normal reference ranges at month 12. The total pregnancy rate of their spouses within 24 months was 65.9% （105/158）. The sperm parameter values at months 6, 12 and were also compared with 1 month, （P〈0.01）. Logistic regression analysis showed that, independent to all other factors, the spouse pregnancy rate was positively correlated （r=0.189, P=-0.000） with the percentage of normal sperm morphology, but negatively correlated （r = -0.171, P=0.004） with the age of the spouse. Conclusion Sperm quality was improved over time after Vasectomy reversal. The sperm densities, the percentages of progressive sperm motility and the percentages of normal sperm mor- phology reached the normal reference ranges at one year after reversal for more than half of the patients in this study Thepregnancy rate of spouses was increased as the percentage of normal sperm morphology increased, whereas it wasdecreased as the spouse＇s age increased.