精索静脉曲张显微外科手术与腹膜后高位结扎术对精子质量、性激素和抗精子抗体影响的对比研究  

Effect of microsurgical varicocelectomy in patients with varicocele compared with retroperitoneal high ligation

作　　者：罗程鹏 袁海川[1] 顾朝辉[1] 李连红[1] 邵佳亮[2] 宋武[1] 王翔[2] 

机构地区：[1]复旦大学附属华山医院宝山分院泌尿外科,上海200431 [2]上海交通大学附属第一人民医院泌尿外科

出　　处：《中国男科学杂志》2016年第8期41-45,共5页Chinese Journal of Andrology

基　　金：上海复旦大学附属华山医院宝山分院青年科研基金项目资助(编号:YKYJ2014-B02);上海申康医院发展中心项目资助(编号:SHDC2015903)

摘　　要：目的比较精索静脉曲张显微外科手术与腹膜后高位结扎术对患者术后抗精子抗体(ASA)、精子质量和性激素水平的影响。方法选取本院2013年6月至2015年1月手术治疗的120例精索静脉曲张患者,根据手术方式分为腹膜后精索静脉高位结扎术53例(传统组)和经外环口显微镜下精索静脉结扎术67例(显微手术组),比较两组患者术后ASA阳性率、精子质量和性激素的差异。结果术前显微手术组和传统组患者的精液量、精子浓度、前向运动精子率、精子活动率、精子存活率和ASA阳性率差异均无统计学意义(P>0.05)。术后3个月,显微手术组患者的精子浓度、前向运动精子率、精子活动率、精子存活率均显著的高于传统组(P<0.05);显微手术组患者的ASA阳性率显著低于传统组患者(P<0.05)。术前显微手术组和传统组患者的血清睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)差异均无统计学意义(P>0.05);术后3个月,显微手术组患者的血清睾酮T显著高于传统组患者(P<0.05),而显微手术组患者的FSH、LH水平均显著低于传统组患者(P<0.05)。结论与腹膜后精索静脉高位结扎术相比,显微外科手术患者术后ASA抗体阳性率、精子质量和性激素水平改善较更为明显。Objective To compare the effect of microsurgical varicocelectomy and traditional retroperitoneal high ligation on anti-sperm antibody（ASA）, sperm quality and sexual hormones in the treatment of patients with varicocele. Methods A series of 120 varicocele patients treated in our hospital from Jun. 2013 to Jan. 2015 were enrolled in the study. Patients were divided into two groups, microsurgery group treated by microsurgical ligation of varicocele veins via sub-inguinal route（n=67） and traditional group treated by retroperitoneal high ligation（n=53）. ASA positive rate, semen analysis result and sexual hormone level were comparatively analyzed before surgery and 3 months after surgery. Results Before surgery, both groups had no significant differences in sperm volume, sperm concentration, rate of sperm with forward movement, sperm motility, rate of sperm activity, survival rate of sperm and the positive rate of ASA（P 〉0.05）. Three months after surgery, the rate of sperm with forward movement, sperm motility rate, activity rate and survival rate in microsurgery group were higher than those in traditional group（P 〈0.05）, and the positive rate of ASA in microsurgery group was lower than that in traditional group（P 〈0.05） as well. Both groups showed no significant differences（P 〉0.05） in serum Testosterone, FSH and LH before surgery. Three months after surgery, serum Testosterone in microsurgery group was higher than that of the traditional group（P 〈0.05）, FSH and LH in microsurgery group were lower than that of the traditional group（P 〈0.05）. Conclusion Microsurgical varicocelectomy showed better improvement in sperm quality, sexual hormones and positive rate of ASA compared with retroperitoneal high ligation in the treatment of patients with varicocele.

关 键 词：显微外科手术 精索静脉曲张 精子能动性 性腺甾类激素 

分 类 号：R699.8[医药卫生—泌尿科学]