显微血管转流术治疗精索静脉曲张合并少精子症

Clinical application of microsurgical shunt in treatment or varicocele with oligospermia

目的研究显微血管转流术在精索静脉曲张合并少精子症的治疗效果和应用价值。方法采用精索内静脉高位结扎加显微血管转流术治疗６６例（７１侧），观察其症状、体征的改善和随访观察精子质量的改变．以及其配偶妊娠率。结果转流术 ７１侧术后７ ｄ体征消失 ５１侧，明显好转 ２０侧；随访半年～１年，症状、体征消失６９例（９７％），精子质量正常或明显好转５２例（７８％）。其中术后精于密度≥２０ × １０９／Ｌ，向前运动的精子比率≥５０％，精子头部形态正常≥３０％有 ３７例（５６． ３％）；精子密度由术前（５～１５）×１０９／Ｌ．术后提高到（１０～１９）×１０９／Ｌ，精子活动率和活动力均有提高 １１例（１６．７％）；术前精子密度＜５×１０９／Ｌ、术后＞５×１０９／Ｌ ４例（５％）。 ２６例配偶已获妊娠，妊娠率 ３９，４％。 结论精索静脉高位结扎加显微血管转流术由于在阻断静脉血逆流的同时，即时建立新的静脉回流通路，更有效的改善睾丸供血，在消除局部症状和体征，改善精子质量，提高妊娠率以及防止复发等方面有良好的疗效。

Objective To study the therapeutic efficacy and the application value of microsurgical shunt in varicocele (VC) with oligospermia. Methods Funicular vein elevatus ligation and microsurgical shunt were applied in 66 patients. Improvements of the symptom, sign,semen quality and the couple's pregnant rate in prognosis visiting were observed. Results in 71 sides by microsurgical shunt,symptom disappeared in 51 cases and obviously improved in 20 cases after 7 days. Half and one year later,symptom and sign were disappeared in 69 cases (97% );semen quality was improved in 52 cases (78% ). In 37 cases (56. 3% ),sperm density was ≥20 × 109/L, progress sperm was ≥50% and morphologically normal sperm was ≥30 %. In 11 cases (16. 7% ),sperm density was increased from 5 × 10,/L- 15 × 109/L before operation to 10 × 109/L- 19 × 109/L after operation,and both of the sperm motility and viability were increased. In 4 cases (5% ),sperm density was increased from less than 5 × 10s/L before operation to more than 5 × 10,/L after operation. In 26 cases,the couple was pregnant;the pregnant rate was 39. 4%' Conclusion Vein elevatus ligation and microsurgical shunt blocked the vein blood reflux,established the new vein circuit and improved the blood supply of testis in the mean time. It was approved that the method was effective in diminishing the local symptom and sign, improving semen quality and preventing recurrence' It was especially suitable for classⅢ exudative VC patients