精索静脉曲张对男性远期生育力影响的回顾性队列研究

Retrospective Cohort Study of Long-term Effect of Varicocele on Fertility

采用回顾性队列研究方法 ,旨在检验精索静脉曲张 (VC)对婚后有生育史的男性远期生育力有无损害作用。10 79对现患不育夫妇中 ,继发不育至少 1年夫妇 79对 ,其中 VC者 (VC组 ) 2 8例 ,精索静脉正常者 (正常组 ) 5 1例。VC组精子参数异常发病率为 5 7.1% ,正常组为 2 5 .5 % ,具有显著性差异。经 L ogistic回归分析 ,控制混杂因素 ,校正RR为 1.84(P<0 .0 5 ) ,95 % CI为 1.1～ 3.1。与正常组相比 ,VC组少精子症发病率较高 (2 8.5 7%对 7.84% ) (P<0 .0 5 ) ,睾丸质地异常者较多 (4 2 .86 %对 3.92 % ) (P<0 .0 0 1)。研究结果提示 VC可引起生育能力进行性下降 ,原有生育能力的 VC男性并不预示能抵御 VC对睾丸生精功能的损害。VC男性应早期检查 ,必要时应行预防性手术治疗 。

Retrospective cohort study was used to test the effects of varicocele (VC) on the long term fertility in the men who were of proven fertility. In 1079 current infertility couples, 79 met our criteria for failure to achieve pregnancy after unprotected coitus for at least 1 year. Among the 79 cases, 28 were diagnosed having VC (VC group) and 51 having no VC served as control group. The incidence of abnormal semen parameter was 57.1 % in the VC group and 25.5 % in the control group with the difference between the two groups being significant. The logistic regression showed that the correcting RR was 1.84 ( P <0.05) and 95 % CI 1.1 to 3.1. As compared with control group, the incidence of oligozoospermia and softened testis in the VC group was higher (28.6 % versus 7.8 %, P <0.05 and 42.9 % versus 3.9 %, P <0.001, respectively). It was suggested that VC could cause a progressively declined infertility and that previous fertility in men with VC did not predict resistance to VC induced impairment of spermatogenesis. The men with VC may benefit from early evaluation and prophylactic varicocelectomy.