比较两种手术方式治疗重度精索静脉曲张对患者生精功能的影响

Comparison of the therapeutic effects of microscopic or traditional palomo varicocelectomy on testicular function in patients with varicoceles of gradeIII

目的应用显微镜下高选择精索静脉高位结扎术与传统的Palomo术,治疗重度精索静脉曲张患者,就两种术式对改善患者精液参数、性激素水平的疗效进行比较.方法选择原发性重度（Ⅲ度）精索静脉曲张患者50例,根据手术方式随机分成两组：A组是显微镜下经腹股沟途径保留精索内动脉、淋巴管的高选择性精索静脉结扎术组,25例;B组为传统Palomo术,25例.比较两组术前和术后3个月、6个月精液参数（精子密度、精子总数和精子活力）、性激素水平[血清卵泡刺激素（FSH）、黄体生成素（LH）、睾酮（T）]、抑制素B（INHB）的变化.结果经过3个月、6个月随访,A、B组术后精子密度、精子总数、精子活力和血清T、INHB水平均提高,手术前后差异具有统计学意义（P〈0.05）;A组术后FSH、LH降低,手术前后差异具有统计学意义（P〈0.05）,术后3个月B组FSH、LH有降低,但手术前后差异无统计学意义（P〉0.05）;术后6个月FSH、LH降低,手术前后差异具有统计学意义（P〈0.05）.术后6个月A组精子活力、INHB提高程度大于B组,差异具有统计学意义（P〈0.05）;术后6个月A组FSH、LH降低程度大于B组,差异具有统计学意义（P〈0.05）;术后A组精子密度、精子总数、血清T提高程度与B组比较差异不明显,无统计学意义（P〉0.05）.结论两种术式治疗精索静脉曲张,均能改善患者的精液质量,而显微外科手术对患者精子活力和INHB提高程度以及FSH、LH的降低程度大于传统的Palomo手术.

Objective To evaluate the therapeutic effects of microscopic or Traditional Palomo varicocelectomy on testicular function （semen parameters and serum reproductive hormones levels） in Patients with Varicoceles of GradeⅢ. Methods All 50 army patients with grade Ⅲ varicocele were randomly divided into two groups. Patients in group A （n=25） were treated with microscopic varicocelectomy, and patients in group B（n=25） with traditional palomo varicocelectomy. Levels of serum follicle stimulating hormone（FSH）,Luteinizing hormone（LH）, testosterone（T）,inhibin B（INHB）, as well as semen parameters such as sperm density,the amount of sperm and the proportion of sperm in grade（a＋b） in the treated patients by two operative methods were comparatively analyzed. Results After 3 months and 6 months of follow-up, sperm density,the amount of sperm, the proportion of sperm in grade（a＋b）,level of serum testosterone（T） and serum inhibin B were all significantly increased in two groups, compared with those before operation （P〈0.05）.After 3 months of follow-up, level of serum FSH and LH were significantly decreased（P〈0.05） after surgery in group A, but no significant change in group B （P〉0.05）. It was significant change after 6 months in two group （P〈0.05）. The degree of sperm motility and level of serum inhibin B were significantly higher in groupA than that in group B （P〈0.05）. There were no significant differences in the degree of sperm density increase, the degree of the amount of sperm and the level of serum testosterone（T） between A group and group B（P〉0.05）. Conclusion Two operative methods all improved spermatogenesis in patients with varicocele of Ⅲ grade, while microsurgical varicocelectomy showed more advantages in enhancing testicular function of patients.