218例精索静脉曲张不育症的疗效多因素回顾性分析

Danhong Tongjing Prescription versus microsurgery in the treatment of varicocele-induced infertility:A retrospective multivariate analysis of 218 cases

目的:探讨丹红通精方及显微手术治疗精索静脉曲张不育症后,精液参数的恢复情况及其影响因素。方法:收集2017年1月至2019年7月我院通过丹红通精方或显微手术治疗的气虚血瘀型精索静脉曲张不育症患者的临床资料,比较治疗后精液参数的恢复情况。以年龄、病程、曲张程度、睾丸体积变化、E/T、FSH、LH为自变量,以治疗后精液参数的增量为因变量,建立多元线性回归模型,使用逐步回归法找出具有统计学意义的自变量。结果:共收集到病例218例,丹红通精方组86例,手术组132例。经过手术或丹红通精方治疗后,精子浓度、前向运动精子百分率及正常形态精子百分数均较治疗前有显著差异;对两组治疗前后的差值进行差异性比较提示:两组间精子浓度及正常形态精子百分数的差值具有统计学差异,前向运动精子百分率的差值无统计学差异。对丹红通精方组线性回归分析结果提示,精索静脉曲张的程度是影响丹红通精方治疗后精液浓度恢复的消极因素(相关系数r=-11.599,R_(a)^(2)=0.044 9);对手术组线性回归分析提示,精索静脉曲张不育症的病程是影响术后精子总数增加的消极因素(相关系数r=-1.837,R_(a)^(2)=0.035 7)。结论:丹红通精方治疗气虚血瘀型精索静脉曲张不育症患者在改善精子动力方面的疗效与显微手术相当。在改善精子浓度及正常形态精子百分数方面,手术疗效更显著。对于双侧精索静脉曲张导致的不育症,双侧达到中度和重度或双侧重度曲张时,建议早期手术治疗。对于双侧轻度或者中度曲张患者或者不愿意手术或者无条件开展显微手术治疗的医院,可以选择丹红通精方治疗。

Objective:To compared the traditional Chinese medicine Danhong Tongjing Prescription(DTP)and microsurgery in the treatment of varicocele(VC)-induced infertility and investigate the factors influencing the recovery of semen parameters of the patients.Methods:We retrospectively analyzed the clinical data on 218 cases of VC-induced infertility with qi-deficiency and blood-stasis treated with DTP(n=86)or by microsurgery(n=132)in our hospital from January 2017 to July 2019,and compared the semen parameters between the two groups of patients after treatment.With age,course of disease,degree of VC,change of the testis volume,estrogen/testosterone(E/T)ratio and levels of FSH and LH as independent variables,and increased semen parameters after treatment as dependent variables,we constructed a multivariate linear regression model and identified statistically significant independ-ent variables.Results:After treatment,sperm concentration and the percentages of progressively motile sperm(PMS)and morpho-logically normal sperm(MNS)were obviously improved in both the DTP and microsurgery groups,with statistically significant differ-ence between the two groups in sperm concentration and MNS,but not in PMS.Linear regression analysis showed that the severity of VC was an influencing factor for the recovery of sperm concentration after treatment in the DTP group(r=-11.599,R_(a)^(2)=0.0449)and the course of VC infertility was a factor affecting the recovery of sperm count in the microsurgery group(r=-1.837,R_(a)^(2)=0.0357).Conclusion:DTP is comparable to microsurgery in improving sperm motility while microsurgery is more effective in increasing the percentage of MNS in the treatment of VC-induced infertility.Early surgery is recommended for the treatment of infer-tility induced by severe bilateral VC,and DTP can be selected for infertility caused by mild or moderate bilateral VC if the patient is unwilling to accept surgery or microsurgery is inaccessible in the hospital.