推拿手法联合微创手术治疗肾虚血瘀型精索静脉曲张性不育症患者的临床观察

Clinical Observation of Massage Combined with Minimally Invasive Surgery in the Treatment of Varicocele Infertility Patients with Kidney Deficiency and Blood Stasis Type

目的:观察中医推拿手法联合微创手术治疗精索静脉曲张性不育症(肾虚血瘀型)的疗效。方法:选取2018年10月至2019年12月在广西中医药大学附属瑞康医院收治的90例肾虚血瘀型静脉曲张性不育症患者,按随机数字法分为3组:推拿手法组、手术组、推拿手法联合手术组,每组各30例。各组疗程均为3个月,比较3组治疗前后3个月的精液质量指标(精子密度、a级精子比例、a+b级精子比例、精子存活率)、精索静脉管径、性激素(卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T))水平、CIPE-5和IEF-S评分、以及随访治疗后6个月配偶受孕率情况。结果:治疗后3个月,手术组、推拿手法联合手术组的精液质量及T水平较治疗前提高,差异均具有统计学意义(P<0.05),而单纯推拿手法组未见明显变化,差异无统计学意义(P>0.05);同时推拿手法联合手术组精子密度、a级精子比例、a+b级精子比例、精子存活率、精索静脉管径缩小程度、性激素水平、CIPE-5和IEF-5评分、及配偶受孕率均优于另外两组(P<0.05)。结论:中医推拿手法联合微创手术治疗肾虚血瘀型精索静脉曲张性不育症患者可提高精液质量,缩小精索静脉管径,调节性激素水平,提高配偶受孕率,值得临床推广应用。

Objective: To observe the curative effect of traditional Chinese massage combined with minimally invasive surgery in the treatment of varicocele infertility(kidney deficiency and blood stasis type). Methods: A total of 90 patients with varicose vein infertility of kidney deficiency and blood stasis type admitted in our hospital from October 2018 to December 2019 were selected and divided into 3 groups according to random number method: Tuina manipulation group, operation group, and combined manipulation operation group, 30 cases in each group. The course of treatment in each group was 3 months. Semen quality indexes of three groups were compared before and after treatment(sperm density, a-grade sperm ratio, a+b-grade sperm ratio, sperm survival rate), spermatic vein diameter, sex hormones( Follicle stimulating hormone(FSH), luteinizing hormone(LH), testosterone(T)) levels, CIPE-5 and IEF-S scores, and the pregnancy rate of spouses was followed up for 6 months. Results: 3 months after treatment, the semen quality and T level of the operation group and the combined manipulation group were improved compared with those before the treatment, and the difference was statistically significant(P <0.05), while there was no significant change in the simple manipulation group. Not statistically significant(P>0.05);Sperm density, a-grade sperm ratio, a+b-grade sperm ratio, sperm survival rate, spermatic vein diameter reduction degree, sex hormone level, CIPE-5 and CIPE-5 The IEF-5 score and the pregnancy rate of spouses were better than the other two groups(P<0.05). Conclusion: TCM massage combined with minimally invasive surgery in the treatment of varicocele with kidney deficiency and blood stasis can improve semen quality, reduce the diameter of the spermatic vein, regulate the level of sex hormones, and increase the pregnancy rate of spouses. It is worthy of clinical application.