手术治疗隐匿性精子症合并精索静脉曲张预后分析

Prognostic Analysis of Surgical Treatment of Occult Spermatozoa Complicated with Varicocele

目的:分析手术治疗隐匿性精子症合并精索静脉曲张患者的临床疗效及预后情况。方法:收集2009年7月至2019年6月在我科诊断为隐匿性精子症合并精索静脉曲张的患者25例,分别采用Palomo术(10例)和MV术(15例)治疗。观察手术前后睾丸体积、性激素水平、精液量、精液pH、精子浓度、精子活力等指标的变化。结果:术后3个月,Palomo术有1例患者精子浓度达到2.0×10^6/mL,3例出现无精症,6例仍为隐匿性精子症;MV术有7例患者精子浓度波动范围在(0.4~19.0)×10^6/mL,有1例无精症,7例仍为隐匿性精子症。术后6个月,Palomo术有5例患者精子浓度波动范围在(0.4~14.0)×10^6/mL,2例无精症,3例仍为隐匿性精子症;MV术有8例患者精子浓度波动范围在(0.1~27.0)×10^6/mL,7例仍为隐匿性精子症。与术前比较,MV术在术后3个月精子浓度即提升,而Palomo术则在术后6个月才显现;MV术在提升精子浓度方面优于Palomo术,但两种术式在精子浓度的变化中无统计学差异(P>0.05)。PR和NP在术后有所提升,但IM有所下降,但组内和组间比较均无统计学差异(P>0􀆰05)。精液量、精液pH值、睾丸体积和性激素水平在手术前后无统计学差异(P>0.05)。结论:隐匿性精子症合并精索静脉曲张首选手术治疗,小部分患者术后可为辅助生殖提供一个短暂的“窗口期”,以获取足够的精子;且MV术较Palomo术提升精子浓度的速度更快。但术后可能成为无精症的情况需与患者做好沟通。

Objective To analyze the clinical efficacy and prognosis of surgical treatment of patients with occult spermatozoa complicated with varicocele.Methods 25 patients diagnosed with occult spermatozoa with varicocele in our department from July 2009 to June 2019 were collected and treated with Palomo surgery(10 cases)and MV surgery(15 cases).The changes of testicular volume,sex hormone level,semen volume,semen pH,sperm concentration,sperm motility and other indicators were compared before and after surgery.Results Three months after surgery,the sperm concentration of one patient in Palomo operation reached 2.0×10^6/mL,3 cases developed azoospermia,and 6 cases were still occult spermatozoa.In 7 cases of MV,the sperm concentration fluctuated in range of(0.4~19.0)×10^6/mL,1 case was azoospermia and 7 cases were still occult spermatozoa.Six months after surgery,the sperm concentration was from 0.4×10^6/mL to 14×106/mL in five patients with Palomo operation,2 cases of azoospermia and 3 cases of occult spermatozoa.8 cases of patients with MV had sperm concentration fluctuations in the range of(0.1~27.0)×10^6/mL,and 7 cases were still occult sperm syndrome.Compared with pre-operation,the sperm concentration of the MV surgery increased at 3 months after the operation,while the Palomo surgery did not appear until 6 months after the surgery;the MV surgery was better than the Palomo surgery in increasing the sperm concentration,but there was no significant difference between the two methods in sperm concentration change(P>0.05).The PR and NP improved after the operation,but the IM decreased.There was no statistical difference within and between groups(P>0.05).There was no significant difference in semen volume,semen pH value,testicular volume and sex hormone levels before and after surgery(P>0.05).Conclusion Surgical treatment is the first choice for occult spermatozoa complicated with varicocele.A small number of patients can provide a short"window period"for assisted reproduction after surgery to obtain enough sperm.MV surgery can increase sperm concentration faster than Palomo surgery.However,the situation that may become azoospermia after surgery requires communication with the patients.