精索静脉显微结扎术联合七叶皂苷治疗精索静脉曲张的有效性与安全性  

Efficacy and safety of microsurgical varicocelectomy combined with aescine in the treatment of varicocele

作　　者：田汝辉[1] 李朋[1] 王俊龙[1] 张时君[2] 王燕[2] 李凤华[2] 陈向锋[3] 李铮[1] 

机构地区：[1]上海交通大学附属第一人民医院泌尿外科,200080 [2]上海交通大学医学院附属仁济医院超声科 [3]上海交通大学医学院附属仁济医院泌尿外科

出　　处：《中华医学杂志》2015年第36期2910-2913,共4页National Medical Journal of China

基　　金：国家自然科学基金重点项目（31230048）;国家重点基础研究发展计划（2013CB947901）

摘　　要：目的 探讨精索静脉显微结扎术联合七叶皂苷治疗精索静脉曲张的疗效与安全性.方法 回顾性分析2013年9月至2015年4月于上海仁济医院和上海市第一人民医院治疗及随访的120例精索静脉曲张患者资料,其中单纯左侧精索静脉曲张106例,双侧精索静脉曲张14例;精索静脉曲张伴不育患者63例,精索静脉曲张伴阴囊疼痛不适症状者57例.41例患者（不育20例,阴囊坠胀不适21例）仅接受了精索静脉显微结扎术治疗（手术组）,79例患者（不育43例,阴囊坠胀不适36例）接受了精索静脉显微结扎术联合七叶皂苷治疗（联合组,七叶皂苷服用方案为300 mg2次/d）.分析并比较两种方案治疗6个月后的效果及术后并发症.结果 治疗6个月后,对精索静脉曲张伴不育患者进行分析发现,手术组和联合组提高精子活力的有效率分别为60.0％（12/20）和83.7％ （36/43）,联合组高于手术组（P＜0.05）;手术组和联合组治疗后性激素相比差异无统计学意义[黄体生成素（LH）：（4.07±1.49）比（4.29±1.32） U/L,卵泡刺激素（FSH）：（5.64 ±2.70）比（5.11±1.25）U/L,睾酮：（16.09±2.25）比（15.98±3.79）μg/L,均P＞0.05];手术组术后受孕率为15.0％（3/20）,联合组受孕率为18.6％（8/43）,两组相比差异无统计学意义（P＞0.05）.对于症状性精索静脉曲张患者分析发现,手术组有效率为76.2％（16/21）,联合组有效率为94.4％（34/36）,联合组高于手术组（P＜0.05）.手术组患者术后2例阴囊水肿,1例复发,未见鞘膜积液等其他并发症发生,而联合手术组未见并发症.结论 精索静脉显微结扎术联合七叶皂苷治疗精索静脉曲张相对单纯手术治疗可一定程度改善精液质量,改善患者阴囊不适症状,防止术后并发症,利于患者术后恢复.Objective To discuss the efficacy and safety of microsurgical varicocelectomy combined with aescine in the treatment of varicocele.Methods A total of 120 patients with varicocele received treatments and follow up in Shanghai Renji Hospital and Shanghai General Hospital between September 2013 and April 2015,63 patients of which were infertile and 57 patients of which were painful varicocele.A total of 106 patients were unilateral varicocele and 14 patients were bilateral varicocele.Forty-one patients were treated with varicocelectomy,and 79 patients were treated with varicocelectomy combined with aescine,300 mg,twice a day,orally.Sperm analysis,pregnancy rate,sex hormone,and complications were recorded after six months treatments.Results There was significant difference in the sperm motility improvement in infertile patients between microsurgical group （60.0%,12/20） and combined therapy group （83.7%,36/43） （P 〈 0.05）.There was no significant difference in levels of sexual hormones in infertile patients between microsurgical group and combined therapy group （luteinizing hormone （4.07 ± 1.49） vs （4.29 ± 1.32） U/L,follicule-stimulating hormone （5.64 ± 2.70） vs （5.11 ± 1.25） U/L,and testosterone （16.09 ±2.25） vs （15.98 ±3.79） μg/L）.The pregnancy rate of infertile patients in microsurgical group and combined therapy group were 15.0% （3/20） and 18.6% （8/43）,respectively,with no statistic difference between these two groups （P 〉 0.05）.The total improvement rates for the pain resolution in microsurgical group and combined therapy group were 76.2% （16/21） and 94.4% （34/36）,respectively,with statistic difference between these two groups （P 〈 0.05）.In the microsurgical group,there were two cases of scrotal edema and one case of reoccurrence after treatment,while no complications were appeared in the combined therapy group.Conclusions Microsurgical varicocelectomy combined with aescine could improve sperm quality,relieve pain,and prevent complication

关 键 词：精索静脉曲张 不育 男(雄)性 精索静脉显微结扎术 七叶皂苷 

分 类 号：R699.8[医药卫生—泌尿科学]