显微镜下精索静脉曲张高位结扎术对睾丸血流动力学及精液质量的影响研究

Effect of spermatic vein ligation on testicular hemodynamics and semen quality

目的探讨显微镜下精索静脉曲张高位结扎术对精索静脉曲张患者睾丸血流动力学及精液质量的影响。方法回顾性分析左侧精索静脉曲张80例患者的临床资料,均行显微镜下精索静脉曲张高位结扎术治疗,应用彩色多普勒超声检测患者术前1周和术后6个月左侧睾丸动脉向心支的收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)和搏动指数(PI),并按WHO标准行精液质量评估。结果术后与术前比较,PSV[(8.64±1.08)cm/s vs(10.23±1.12)cm/s]、RI[(0.52±0.04)vs(0.56±0.01)]及PI[(0.92±0.01)vs(1.07±0.02)]均降低(均P<0.05),而EDV[(4.11±0.22)cm/s vs(3.81±0.23)cm/s]升高(P<0.05),精子密度[(44.29±4.40)×106个/ml vs(38.15±5.19)106个/ml]、前向运动精子比例[(33.57±3.48)%vs(26.65±5.53)%]、正常形态精子比例[(41.29±3.22)%vs(32.10±3.34)%]均升高(均P<0.05)。结论显微镜下精索静脉曲张高位结扎术可改善精索静脉曲张患者睾丸的血流动力学参数及精液质量,值得临床推广。

Objective To investigate the effect of the spermatic vein ligation under the microscope on testicular hemodynamics and semen quality. Methods The clinical data of 80 patients with varicocele receiving vein ligation under the microscope in our hospital from April 2011 to April 2015 were retrospectively analyzed. The parameters of the peak systolic velocity（PSV）, end diastolic velocity（EDV）, resistive index（RI） and pulsatility index（PI） of bilateral intratesticular centripetal artery were examined by color Doppler sonography（CDS） before and 6 months after surgery. The quality of semen was evaluated with WHO reference range of human semen. Results The mean values of PSV [（8.64±1.08）cm/s vs（10.23±1.12）cm/s], RI[（0.52±0.04） vs（0.56±0.01）] and PI [（0.92±0.01） vs（1.07±0.02）] were significantly reduced, where EDV [（4.11±0.22） cm/s vs（3.81 ±0.23） cm/s] was significantly increased after operation. The sperm concentration [（44.29 ±4.40）million/ml vs（38.15±5.19） million/ml], sperm motility[（33.57±3.48）% vs（26.65±5.53）%] and sperm morphology [（41.29±3.22）% vs（32.10 ±3.34）% ] were significantly improved. Conclusion The spermatic vein ligation under microscope can significantly improve the testicular blood supply and the quality of sperm.