腹腔镜下精索静脉高位结扎术对精液质量影响的临床观察  

Clinical observation on the effect of laparoscopic varicocelectomy forejaculum quality in patients with varicocele

作　　者：张溪[1] 侯垒[1] 崔功静 高玉杰[1] 

机构地区：[1]北京航天总医院泌尿外科,北京100076

出　　处：《国际外科学杂志》2016年第3期181-185,共5页International Journal of Surgery

摘　　要：目的研究腹腔镜下精索静脉高位结扎术对精液质量的影响。方法收集北京航天总医院泌尿外科2013年10月-2015年6月接受腹腔镜下精索静脉高位结扎术的左侧精索静脉曲张患者50例，根据曲张静脉直径分为Ⅱ级12例（A组），Ⅲ级38例（B组），术前及术后1、3、6个月行精液常规检查，比较两组精液量、精子密度、精子总数、a＋b＋c级精子活动率、a＋b级精子活动率、a级精子活动率、精子存活率及正常形态精子率。结果50例患者术后均随访6个月以上，术后1、3、6个月精液量与术前比较差异无统计学意义（P〉0．05）；术后1个月精子密度、精子总数、精子活动率、精子存活率及正常形态精子率较术前有所提高，但差异无统计学意义（P〉0．05）；而术后3个月较术前及术后1个月明显改善，差异有统计学意义（P〈0．05）；术后6个月与术后3个月比较差异无统计学意义（P〉0．05）。两组组间比较术前精液常规比较差异无统计学意义（P〉0．05）；术后6个月精子存活率比较差异有统计学意义（P〈0．05）。组内比较A组术后1个月精子密度较术前明显改善，差异有统计学意义（P〈0．05）；B组术后1个月精子密度、精子活动率及正常形态精子率较术前明显改善，差异有统计学意义（P〈0．05）。结论腹腔镜下精索静脉高位结扎术可显著改善精索静脉曲张患者精液质量，对于精液质量下降的精索静脉曲张患者建议早期腹腔镜手术治疗，术后3个月精液参数明显改善并维持稳定。Objective To observe the clinical effects of laparoscopic varicocelectomy to ejaculum quality in pa- tients with varicocele. Methods Fifty patients with varicocele were treated by laparoscopic varicocelectomy. The patients were grouped into Group A and Group B according to venous diameter. Semen parameters including semen volume, sperm density, sperm motilities（a ＋ b ＋ c）, sperm motilities（a ＋ b）, sperm motilities（a）, total sperms, normal spermmorphology rate and sperm survival rate were measured and recorded before operation and 1, 3, 6 months after operation. Results After the follow- up of 6 months above in 50 cases, there is no significant differ- ence about semen volume preoperative and postoperative at different follow-up time （P 〉 0.05 ）. In some semen pa- rameters（sperm density, sperm motilities, total sperms, normal spermmorphology rate）, there is no significant difference between preoperative and postoperative 1 month （ P 〉 0.05 ）, but there is significant difference between postoperative 3 months and postoperative 6 months（P 〈 0.05 ）. There is no significant difference in preoperative se- men parameters between the 2 groups （P 〉 0.05 ）, but there is significant difference in postoperative 6 month （P 〈 0.05 ）. In Group A, there is significant difference in sperm density between preoperative and postoperative 1 month （P 〈 0.05 ）. In Group B, there is significant difference in sperm density, sperm motilities and normal spermmor- phology rate between preoperative and postoperative 1 month（ P 〈 0.05）. Conclusions Laparoscopic varicocelec- tomy has a positive effect on sperm parameters, it can significantly improve postoperative semen parameters. Semen parameters improve to a relatively stable level by 3 months following operation.

关 键 词：精索静脉曲张 腹腔镜 精液分析 病例对照研究 

分 类 号：R697.24[医药卫生—泌尿科学]