彩色多普勒高频超声在精索静脉曲张不育症检查中的价值

Clinical value of the high frequency color Doppler ultrasound examination in infertility patients with varicocele

目的:探讨彩色多普勒高频超声在精索静脉曲张(VC)不育症检查中的价值,并探讨不同超声分级的VC病人的精液指标变化。方法:选择124例不育且患左侧VC的男性病人作为研究对象,并选择41名健康育龄期男性作为对照组。采用多普勒高频超声检查精索静脉的最大内径(DR)以及Valsalva试验时最大内径(DV)、最大返流速度(Vmax)及返流持续时间(TR),记录睾丸体积;采用伟力图像分析系统分析精液体积、精子浓度、活力及形态。结果:亚临床VC(SVC)、VCⅠ、VCⅡ、VCⅢ各组DR、DV、Vmax、TR显著高于对照组(P<0.01),SVC、VCⅠ、VCⅡ、VCⅢ4组DR、DV、Vmax、TR逐渐升高,且组间比较差异均有统计学意义(P<0.01);SVC、VCⅠ、VCⅡ、VCⅢ4组左侧睾丸体积逐渐减小且显著低于对照组(P<0.05~P<0.01),各组右侧睾丸也逐渐减小,仅VCⅡ组右侧睾丸与对照组差异有统计学意义(P<0.05);SVC、VCⅠ、VCⅡ、VCⅢ4组精子浓度、精子活力、前向运动精子百分比、精子存活率及正常形态率均逐渐降低,且与对照组及组间比较差异均有统计学意义(P<0.05~P<0.01)。结论:彩色多普勒高频超声可较客观地反映睾丸体积、精索静脉内径大小及血流动力学等指标,结合精液参数,对男性不育症具有较好的预测作用。

Objective： To investigate the clinical value of the high frequency color Doppler ultrasound examination in infertility patients with varicocele（ VC）,and explore the indictor change of semen in different classifications patients with VC. Methods： One hundred and twenty-four infertility male patients with left VC were investigated,and 41 cases of healthy childbearing age men were set as the control group. The DR,DV,Vmax and TR of spermatic vein were detected using high frequency ultrasound Doppler,and the semen volume and sperm concentration,vitality and form were analyzed using WEILI image analysis system. Results： The DR,DV,Vmax and TR in SVC,VC Ⅰ,VC Ⅱ and VC Ⅲ groups were significantly higher than those in control group（ P〈0. 01）. The DR,DV,Vmax and TR in SVC,VC Ⅰ,VC Ⅱ and VC Ⅲ groups gradually increased,and the differences of whose between SVC,VC Ⅰ,VC Ⅱand VC Ⅲ groups were statistically significant（ P〈0. 01）. The left testicular volume in SVC,VC Ⅰ,VC Ⅱ and VC Ⅲ groups gradually decreased,and whose were significantly lower than that in control group（ P〈0. 05 to P〈0. 01）. The right testicular volume gradually decreased in each group,but which only in VC Ⅱ group was lower than that in control group（ P〈0. 05）. The sperm concentration,sperm vitality,percentage of forward movement sperm,sperm survival rate and normal form in SVC,VC Ⅰ,VC Ⅱ and VC Ⅲ groups gradually decreased,and the differences of whose in all groups were statistically significant（ P〈0. 05 to P〈0. 01）.Conclusions： High frequency color Doppler ultrasound can objectively reflect the testicular volume,spermatic vein diameter and hemodynamic index,and which combined with semen parameters have good predictive value in male infertility.