显微镜经腹股沟下MSV治疗VC性不育症的效果及对患者精子质量、性激素水平的影响

Effectiveness of Microscopic Subinguinal Spermatic Vein Ligation in the Treatment of Varicocele Infertility and the Effect on Sperm Quality and Sex Hormone Level of Patients

目的:探讨显微镜经腹股沟下精索静脉结扎术(MSV)治疗精索静脉曲张(VC)性不育症的效果。方法:选取2019年1月—2020年1月佳木斯市中心医院收治的112例VC性不育症患者作为研究对象,按照随机数表法分为对照组和观察组,每组各56例。对照组采用开放经腹膜后结扎手术,观察组采用MSV治疗。比较两组患者手术情况、精子质量、性激素水平、疗效及并发症。结果:观察组患者手术时间长于对照组,术中发现精索血管数量多于对照组,术后住院时间短于对照组,差异有统计学意义(χ^(2)=11.567、20.351、15.011,P<0.05);术后3个月,两组患者精子密度、总数、活力a级和a+b级均升高,且观察组高于对照组,差异有统计学意义(t=9.051、7.909、15.315、6.953,P<0.05);术后3个月,观察组血清总睾酮(TT)水平高于对照组,血清黄体生成素(LH)、卵泡刺激素(FSH)水平低于对照组,差异有统计学意义(t=7.813、19.304、9.136,P<0.05);观察组总有效率高于对照组,并发症发生低于对照组,差异有统计学意义(χ^(2)=5.303、5.225,P<0.05)。结论:MSV治疗VC性不育症可改善患者精子质量,纠正生殖内分泌激素失调,提高疗效与配偶妊娠率,并发症少,安全可靠。

Objective:To investigate the effectiveness of microscopic subinguinal spermatic vein ligation(MSV)in the treatment of varicocele(VC)infertility.Methods:112 patients with VC infertility admitted to the hospital from January 2019 to January 2020 were selected as study subjects and divided into control and observation groups according to the random number table method,with 56 cases in each group.The control group was treated with open retroperitoneal ligation,and the observation group was treated with MSV.The surgical conditions,sperm quality,sex hormone levels,efficacy and complications were compared between the two groups.Results:The observation group had longer operation time than the control group,more intraoperative spermatic vessels were found than the control group,and the postoperative hospital stay was shorter than the control group,with statistically significant differences(χ^(2)=11.567,20.351,15.011,P<0.05).At 3 months postoperatively,sperm density,total number,viability grade a and grade a+b were higher in both groups and were higher in the observation group than in the control group,with statistically significant differences(t=9.051,7.909,15.315,6.953,P<0.05).At 3 months postoperatively,sperm quality in the observation group,serum T level was higher than that in the control group,and serum LH and FSH levels were lower than those in the control group,with statistically significant differences(t=7.813,19.304,9.136,P<0.05).The overall efficiency of the observation group was higher than that of the control group,and the occurrence of complications was lower than that of the control group,with statistically significant differences(χ^(2)=5.303,5.225,P<0.05).Conclusion:MSV for VC infertility can improve sperm quality,correct reproductive endocrine hormone imbalance,and improve the efficacy and pregnancy rate of the spouse with few complications,which is safe and reliable.