腹腔镜下保留睾丸动脉的曲张精索静脉高位结扎术对少弱精子症患者睾丸血流变化的影响

Effect of laparoscopic varicocelectomy with testicular artery preservation on testicle hemodynamics in patients with oligoasthenospermia

目的探讨腹腔镜下保留睾丸动脉的曲张精索静脉高位结扎术对少弱精子症患者睾丸血流变化的影响。方法抽取2017年1月至2020年1月南京医科大学附属苏州医院收治的精索静脉曲张少弱精子症患者26例,均行腹腔镜下保留睾丸动脉的曲张精索静脉高位结扎术,最终获得19例(24侧)资料完整者,另7例因随访资料不完整而丢失。评估19例患者精液常规以及睾丸血流改变情况。结果19例(24侧)患者术后3、6个月时精子质量和精子活力较术前1周改善(P=0.001);术后3个月与术后6个月比较,精子质量差异有统计学意义(P=0.023),但精子活力差异未见统计学意义(P=0.441)。术前1周与术后3个月比较,收缩期峰值流速(PSV)、舒张末期流速(EDV)差异未见统计学差异(P=0.160、0.180),但阻力指数(RI)差异有统计学意义(P=0.01);术后3个月与术后6个月比较,PSV、EDV、RI差异未见统计学意义(P=0.730、0.130、0.120)。结论腹腔镜下保留睾丸动脉的曲张精索静脉高位结扎术可降低血流阻力,改善睾丸血流供应,有利于精子生成,且改善效应在术后3个月即可达峰值。

Objective To investigate the effect of laparoscopic varicocelectomy with testicular artery preservation on testicle hemodynamics in patients with oligoasthenospermia.Methods A total of 26 patients with varicocele and oligospermia who were admitted to the Affiliated Suzhou Hospital of Nanjing Medical University,from January 2017 to January 2020 were selected.All patients underwent laparoscopic varicocelectomy with testicular artery preservation.Nineteen cases(24 sides)with complete data were finally obtained,and the other 7 cases were lost due to incomplete follow-up data.The semen routine and testicular blood flow changes of 19 patients were assessed.Results The sperm concentration and motility of 19 patients(24 sides)in both postoperative 3 months and 6 months were improved compared with that in preoperative 1 week(P=0.001);there was a significant difference in sperm concentration between postoperative 3 months and 6 months(P=0.023),but the difference in sperm motility was not significant(P=0.441).There were no differences in peak systolic velocity(PSV)and end-diastolic velocity(EDV)between preoperative 1 week and 3 months(P=0.160,0.180),but the difference in resistance index(RI)was significant(P=0.01);there was no significant differences in PSV,EDV,and RI between postoperative 3 months and 6 months(P=0.730,0.130,0.120).Conclusions Laparoscopic varicocelectomy with testicular artery preservation can reduce the blood flow resistance,improve the blood flow supply of the testis,and is beneficial to sperm production,and the improvement effect can reach a peak within 3 months after varicocelectomy.