评估不同处理方式对单侧睾丸扭转患者远期生育能力的影响

Influence of different treatments of unilateral testicular torsion on the long-term fertility of the patient

目的:评估单侧睾丸扭转患者不同处理方式对远期生育能力的影响。方法:对2000年1月至2014年12月收治的符合纳入标准的单侧睾丸扭转患者进行病历资料分析和生育情况随访,通过比较睾丸体积、精液质量、生殖激素参数、自然受孕率(NPR)和自然受孕时间(TTP),探讨单侧睾丸扭转对患者生育的影响。结果:共有92例单侧睾丸扭转患者纳入本研究,其中行单侧睾丸切除术49例(OE组),行睾丸复位固定术43例(OP组),剔除未婚、离异、无生育要求、非自然受孕及失访15例,符合纳入标准者77例。追访其婚姻生活及配偶生育情况发现,OE组40例与OP组37例患者在结婚年龄、平均性生活频率、性功能方面均未见显著差异。与OP组对侧睾丸相比,OE组的对侧睾丸体积大,但无统计学意义[(17.62±2.15) ml vs (16.86±2.05) ml,P>0.05];精子质量低,但差异不明显(精液量、精子浓度、精子活率、前进运动精子百分率、畸形精子百分率分别为[(4.09±0.89) ml vs(4.11±0.76) ml、(27.60±7.58)×10^(6)/ml vs(27.74±6.80)×10^(6)/ml、(60.14±14.50)%vs(60.29±16.36)%、(38.37±10.88)%vs(38.82±9.73)%和(29.80±7.29)%vs(29.55±7.03)%,P均>0.05];FSH、LH和T水平低,但无明显差异[(8.01±2.31) IU/L vs(8.12±2.63) IU/L、(15.05±4.20) IU/L vs(15.46±4.76) IU/L和(19.06±3.60) nmol/L vs(19.46±4.02) nmol/L,P均>0.05];NPR低,但差异无统计学意义(75.0%vs 83.8%,P>0.05);TTP长,但无统计学意义[(18.0±5.7)个月vs(14.6±3.8)个月,P>0.05]。结论:单侧睾丸切除的睾丸扭转患者精液质量、配偶NPR低于复位固定的睾丸扭转患者,且配偶TTP较长,但并未引起生育能力显著下降;而可复位性的睾丸扭转复位后基本不会影响患者的生育功能。

Objective: To evaluate the effects of different treatments of unilateral testicular torsion on the long-term fertility of the patient. Methods: We reviewed the clinical and fertility-related follow-up data on 92 cases of unilateral testicular torsion treated by orchiectomy(the OE group, n = 49) or orchiopexy(the OP group, n = 43) between January 2000 and December 2014. We compared the testis volume, semen parameters, reproductive hormone indexes, natural pregnancy rate(NPR) and time to pregnancy(TTP) between the two groups, and analyzed the influence of orchiectomy and orchiopexy on the fertility of the patients. Results: Totally, 77 of the men met the inclusion criteria and included in this study, 40 in the OE and 37 in the OP group. Follow-up data exhibited no statistically significant difference between the two groups of patients in the age of marriage, mean frequency of intercourse or sexual function. The men in the OE group, compared with those in the OP group, showed a larger volume of the opposite testis([17.62 ± 2.15] vs [16.86 ± 2.05] ml, P > 0.05), but lower semen volume([4.09 ± 0.89] vs [4.11 ± 0.76] ml, P > 0.05), sperm concentration([27.60 ± 7.58] vs [27.74 ± 6.80] ×10^(6)/ml, P > 0.05), sperm motility([60.14 ± 14.50]% vs [60.29 ± 16.36]%, P > 0.05), and percentages of progressively motile sperm(PMS)([38.37 ± 10.88]% vs [38.82 ± 9.73]%, P > 0.05) and morphologically abnormal sperm(MAS)([29.80 ± 7.29]% vs [29.55 ± 7.03]%, P > 0.05), lower levels of FSH([8.01 ± 2.31] vs [8.12 ± 2.63] IU/L, P > 0.05), LH([15.05 ± 4.20] vs [15.46 ± 4.76] IU/L,P > 0.05) and T([19.06 ± 3.60] vs [19.46 ± 4.02] nmol/L, P > 0.05), lower NPR(75.0% [30/40] vs 83.8% [31/37], P > 0.05) and longer TTP([18.0 ± 5.7] vs [14.6 ± 3.8] mo, P > 0.05). Conclusion: For patients with unilateral testicular torsion, orchiectomy achieved a lower semen quality and NPR and a longer TTP than orchiopexy, but induced no significant fertility decrease. Detorsion of the torsioned testis little affects the fertility of the patient.