显微镜下精索静脉结扎术治疗非梗阻性无精子症伴精索静脉曲张的疗效与安全性

Efficacy and safety study of microsurgical varicocelectomy in the treatment of non-obstructive azoospermia with varicocele

目的 探讨显微镜下精索静脉结扎术治疗非梗阻性无精子症(NOA)伴精索静脉曲张患者的疗效与安全性.方法 本研究回顾性收集了2015年3月至2017年6月上海市第一人民医院收治的141例NOA伴精索静脉曲张患者资料,其中单纯左侧精索静脉曲张110例,右侧精索静脉曲张1例,双侧精索静脉曲张30例;Ⅰ度精索静脉曲张7侧例,Ⅱ度精索静脉曲张121侧例,Ⅲ度精索静脉曲张43侧例.患者均接受经外环下途径的显微镜下精索静脉结扎术,随访至少6个月,统计分析术后精液改善情况、配偶妊娠结局及并发症等数据.结果 本研究失访11例,共有18例(18/130,13.8%)术后精液出现精子,其中6例(6/130,4.6%)配偶自然怀孕,5例(5/130,3.8%)配偶经卵细胞质内单精子注射(ICSI)技术怀孕.剩余112例患者中有26例接受了显微镜下睾丸取精术,4例(4/26,15.4%)取精成功,其中2例患者配偶经ICSI怀孕,另2例患者配偶正在准备.共有2例患者术后出现切口感染.结论 显微镜下精索静脉结扎术能够一定程度改善NOA伴精索静脉曲张患者精液质量,使其自然生育,手术并发症少,可用于临床NOA伴精索静脉曲张的临床治疗.

Objective To discuss the efficacy and safety of subinguinal microsurgical varicocelectomy in the treatment of non-obstructive azoospermia ( NOA) with varicocele.Methods The clinical data of 141 patients with NOA and varicocele who underwent subinguinal microsurgical varicocelectomy from March 2015 to June 2017 in Shanghai General Hospital was collected .One hundred and ten patients suffered from varicocele on the left side , 1 on the right side , and the rest ( 30 cases ) were bilateral varicocele. Grade Ⅰ varicocele were found on 7 sides ( the right and left side was count respectively), grade Ⅱ on 121 sides, and grade Ⅲ on 43 sides.Sperm analysis, pregnancy rate and complications were recorded after at least 6 months since operation .Results Eleven cases were lost during the follow-up.Eighteen of the remaining 130 NOA patients processed successful sperm retrieval in post-operative semen analysis (18/130, 13.8%).Six couples(6/130, 4.6%) succeeded in natural pregnancy . Five couples (5/130, 3.8%)underwent successful pregnancy following with intracytoplasmic sperm injection (ICSI) .Twenty-six out of the remaining 112 patients underwent the micro dissection testicular sperm extraction (micro-TESE), and 4 patients got a successful sperm retrieval (4/26, 15.4%).Among them, 2 couples had successful pregnancy with ICSI .Totally 2 cases of postoperative infection of incision were found . Conclusions Microsurgical varicocelectomy had a beneficial effect on sperm quality of patients suffered from NOA with varicocele to some extent , even leading to unassisted pregnancy or avoiding micro-TESE before ICSI.Microsurgical varicocelectomy could be applied in the treatment of NOA with varicocele .