显微镜下低位精索静脉结扎术242例疗效分析

Efficacy analysis of low spermatic vein ligation under microscope for 242 varicocele patients with infertility

目的分析显微镜下低位精索静脉结扎术对合并不育的精索静脉曲张的治疗效果,评估其临床疗效和应用价值。方法回顾性分析242例合并不育的精索静脉曲张患者接受显微镜下低位精索静脉结扎手术后的精液质量、阴囊温度、精索静脉内径及配偶怀孕率,记录并发症的发生。结果242例患者术后平均精子密度较术前有显著改善[(39.68±15.31)×106/mL vs.(13.51±5.12)×106/mL](P<0.05)。术后平均精子活力(a+b级)较术前明显提高[(58.44±9.84)%vs.(21.03±10.18)%](P<0.05),平均a级精子活力也显著提升[(25.06±5.89)%vs.(11.41±4.63)%](P<0.05)。术后阴囊各部位平均温度与术前相比,其降幅差异均有统计学意义[阴茎根部左侧(36.70±0.31)℃vs.(36.89±0.33)℃,右侧(36.65±0.34)℃vs.(36.72±0.39)℃;阴囊中部左侧(36.51±0.29)℃vs.(36.68±0.34)℃,右侧(36.10±0.30)℃vs.(36.57±0.36)℃;阴囊底部左侧(36.20±0.24)℃vs.(36.76±0.21)℃,右侧(36.20±0.24)℃vs.(36.47±0.29)℃](P均<0.05)。彩超下精索静脉内径在术后降至2mm以下的患者占76.03%(184例)。术后持续随访一年,均未出现睾丸水肿、鞘膜积液、睾丸萎缩等并发症,配偶怀孕率达31.8%(77例)。结论显微镜下低位精索静脉结扎术能显著改善伴有不育的精索静脉曲张患者的精液质量,包括精子密度、精子活力(a+b级),以及对阴囊降温机制的恢复有明显作用,提高配偶的怀孕率,且并发症少,是一种安全、有效、值得推广的手术方式。

Objective To explore the efficacy of low spermatic vein ligation under microscope in the treatment of varico-cele complicated with infertility. Methods Clinical data of 242 varicocele patients with infertility who underwent microsurgi-cal spermatic vein ligation were analyzed,including semen quality,scrotal temperature, the inner diameter of spermatic vein and the pregnancy rate of the spouse. The incidence of complications was recorded. Results After surgery, the mean sperm density was significantly improved [（39.68＋15.31））×10^6/mL vs. （13.51 ＋5.12））×10^6/mL] （P〈0.05）; the mean sperm motility （a＋bgrade） was markedly higher [（58.44＋9.84）% vs. （21.03＋10.18）%] （P〈0.05）,including the activity of mean a-grade sperm [（25.06±5.89）% vs. （11.41＋4.63）% （P〈0.05）.Moreover,the average temperature of each part of the scrotum was statistically reduced root of the penis [left side （36.70±0.31）℃ vs. （36.89±0.33）℃]（P〈0.05）,right side [（36.65±0.34）℃ vs. （36.72±0.39）℃]（P〈0.05）; the middle of the scrotum：left side [（36.51±0.29）℃ vs. （36.68±0.34）℃]（P〈0.05）,right side [（36.10±0.30）℃ vs. 36.57±0.36℃]（P〈0.05）; bottom of the scrotum： left side [（36.20±0.24）℃ vs. （36.76±0.21）℃ ]（P〈0.05） ,right side [（36.20±0.24）℃ vs. （36.47±0.29）℃ ]（P〈0.05）. The inner diameter of spermatic vein dropped to below 2 mm after the surgery in 76.03% （184/242） patients. During the follow-up of 12 months,no complica-tions like scrotal swelling, testicular atrophy or hydrocele of tunica vaginalis were observed, and 31.8% patients＇ spouse （77/ 242） were pregnant. Conclusions Microsurgical low spermatic vein ligation can significantly improve the semen quality in varicocele patients with infertility,including sperm density and sperm motility （a＋b grade）. It also has a significant effect on the recovery of scrotal cooling mechanism,and can increase the rate of spouse＇s pregnancy. It is a safe and effective treatment, which deserves to be popularized.