睾丸微石症合并精索静脉曲张36例分析

Retrospective analysis of 36 cases of testicular microlithiasis combined with varicocele

目的:探讨睾丸微石症合并精索静脉曲张患者的临床诊治方法,提高患者的睾丸储备功能。方法:回顾性报告并分析2011年3月至2013年2月36例睾丸微石症合并精索静脉曲张患者的病历资料,其中弱精症30例,精液质量正常6例。所有弱精症患者均行MV手术治疗,精液正常患者中1例CTM合并Ⅲ°VC有临床表现者行MV手术治疗,其余5例无临床表现患者无特殊处理;所有患者均每半年复查1次,彩色多普勒超声检查睾丸微石程度,精液CASA检查患者精液质量。结果:30例接受手术的弱精症患者有29例术后精液质量(精液密度,A+B级活动精子率,精子畸形率)明显改善,1例CTM患者精液质量及睾丸微石程度与手术前比较均无明显变化,且LTM患者的改善情况明显优于CTM患者,但所有患者的睾丸微石程度无明显变化;1例CTM合并Ⅲ°VC精液质量正常患者接受手术后精液质量及睾丸微石程度均无明显变化;1例CTM合并Ⅱ°VC和1例LTM合并Ⅲ°VC精液质量正常患者半年后精液出现异常,后接受MV手术治疗;2例LTM合并Ⅲ°VC精液质量正常患者2年后精液质量无变化,但其中1例睾丸微石程度加重,转为CTM;1例LTM合并Ⅰ°VC患者精液质量及睾丸微石程度无变化。结论:TM合并VC患者应该定期复查精液常规及泌尿生殖彩超,且MV手术对TM合并VC弱精症患者的精液质量有明显改善,LTM患者改善的程度明显优于CTM患者,对精液正常的患者可能会延缓精液质量恶化及睾丸微石程度加重。

Objectives： To investigate the clinical diagnosis and treatment of patients with testicular microlithiasis combined with varicocele so as to improve testicular reserve function of patients. Methods： A retrospective analysis was done on the medical records of 36 patients with testicular microlithiasis（ TM） combined with varicocele from March 2011 to February 2013,including 30 patients with weak azoospermia,6 patients with normal quality of semen. All patients with weak azoospermia were treated with microsurgical varicocelectomy（ MV） surgery. One patient with normal semen CTM combined with III°VC were treated with MV surgery and the remaining 5 patients without clinical manifestations were treated with no special treatment. All patients were re-examined once every 6 months with color Doppler ultrasonography to check the degree of TM and with semen CASA to check semen quality of patients. Results： Among the 30 patients with weak azoospermia treated with surgery,29 patients were significantly improved in the aspect of semen quality,including sperm density,（ a ＋ b） grade motile sperm and sperm deformity rate. The sperm density,（ A ＋ B） level of sperm motility,sperm deformity rate,and the degree of TM of one patient with CTM had no significant improvement. And the improvement in the patients with LTM was significantly better than the patients with CTM. But the degree t of TM of all patients had no significant change.Conclusion： The patients with TM and VC should be periodically reviewed by semen and urogenital ultrasound. Semen quality of weak azoospermia patients with TM and VC is improved significantly after MV surgery,and the degree of improvement in patients with LTM is significantly better than patients with CTM. MV surgery may delay the deterioration of semen quality and the aggravation of TM in patients with normal semen.