多中心研究评价麒麟丸联合手术治疗精索静脉曲张伴不育症的疗效

Varicocelectomy combined with Qilin Pills for the treatment of varicocele-associated male infertility: A multi-center retrospective study

目的:探索麒麟丸联合手术治疗对精索静脉曲张伴不育症的治疗效果。方法:回顾性分析2017年10月到2019年3月间于复旦大学附属中山医院、上海交通大学医学院附属国际和平妇幼保健院、上海长征医院、上海中医药大学附属曙光医院及复旦大学附属华东医院就诊手术治疗的精索静脉曲张伴不育症患者共180例。其中单纯手术治疗的对照组67例,另术后1周开始予以麒麟丸治疗者113例作为研究组,麒麟丸治疗周期为6个月。所有患者术前及术后第1、2、3、6个月检查精液常规,术前及术后6个月查精子DNA碎片率(DFI)。结果:全部患者术后及治疗期间无明显不适主诉及严重并发症。对照组术前精液检查提示精子浓度为(17.1±12.4)×10^6/ml,前向运动精子(PR)百分率为(22.8±10.9)%,精子活率为(33.6±13.5)%;DFI为(16.5±7.6)%;术后6个月复查精子浓度为(29.5±14.4)×10^6/ml,PR为(43.7±11.7)%;精子活率为(54.5±12.0)%;DFI为(13.3±4.4)%;术后6个月内配偶自然妊娠22例。研究组术前精液检查提示精子浓度为(16.8±10.7)×10^6/ml,PR为(21.8±11.3)%;精子活率为(32.8±14.0)%;DFI为(16.5±7.6)%;术后6个月复查精子浓度为(38.9±24.1)×10^6/ml,PR为(39.6±13.3)%;精子活率为(50.1±15.0)%;DFI为(11.8±4.8)%;术后6个月内自然妊娠55例。结论:麒麟丸联合手术治疗精索静脉曲张伴不育可更有效提高患者精液质量及配偶自然妊娠率。

Objective:To investigate the effect of varicocelectomy(VCE)combined with medication of Qilin Pills(QLP)in the treatment of varicocele(VC)-associated male infertility.Methods:We retrospectively analyzed the clinical data on 180 cases of VC-associated male infertility treated in our hospitals between October 2017 and March 2019,67 by VCE(the control group)and 113 by VCE in combination with 6-month medication of QLP after operation(the VCE+QLP group).We obtained the semen parameters from the patients before and at 1,2,3 and 6 months after surgery,measured their sperm DNA fragmentation index(DFI)before and at 6 months after operation,and recorded the rate of pregnancy at months postoperatively.Results:There were no severe complications in any of the cases after surgery or during the whole course of medication.Compared with the baseline,the patients in control group showed significant increases at 6 months postoperatively in sperm concentration([17.1±12.4]vs[29.5±14.4]×10^6/ml,P<0.01),sperm motility([33.6±13.5]%vs[54.5±12.0]%,P<)and the percentage of progressively motile sperm(PMS)([22.8±10.9]%vs[43.7±11.7]%,P<)but a remarkable decrease in sperm DFI(16.5±7.6]%vs[13.3±4.4]%,P<),and so did those in the VCE+QLP group in sperm concentration([16.8±10.7]vs[38.9±24.1)×10^6/ml,P<0.01),sperm motility([32.8±14.0]%vs[50.1±15.0)%,P<),PMS([21.8±11.3]%vs[39.6±13.3]%,P<)and sperm DFI([17.8±9.0]%vs[11.8±4.8]%,P<).There were even more statistically significant differences between the control and VCE+QLP groups at 6 months in the above semen parameters(P<0.01)and in the rate of natural pregnancy(32.8%[22/67]vs 48.7%[55/113],P<0.05).Conclusion:Varicocelectomy combined with medication of Qilin Pills can effectively improve semen quality and increase the rate of natural pregnancy in the treatment of VC-associated male infertility.