腹腔镜下精索静脉高位结扎术的临床疗效分析及对精子质量影响的相关性研究  

The effect analysis of laparoscopic varicocele high ligation and the correlation study of semen quality influence by surgery

作　　者：黄芳[1] 王甲磊 熊羊 张向阳[1] 

机构地区：[1]中南大学湘雅医院泌尿外科,湖南长沙410008

出　　处：《国际泌尿系统杂志》2017年第6期879-883,共5页International Journal of Urology and Nephrology

摘　　要：目的 研究腹腔镜下精索静脉高位结扎术对精索静脉曲张不育患者的临床疗效及其精子质量在术后变化规律.方法 收集2012年1月至2015年6月因婚后不育就诊于本院泌尿外科并接受腹腔镜下精索静脉高位结扎术治疗患者60例,其中有阴囊坠胀不适或坠痛症状者27例.所有患者于术后1、3、6个月进行随访并分别行精液分析检查.分析所有患者术后手术并发症发生、临床症状缓解情况及精子质量随随访时间变化规律.结果 所研究病例中,术后随访1例患者出现阴囊水肿（1.76％）,5例患者出现阴囊气肿（8.33％）,且在术后1个月均已消失.术前27例患者有阴囊坠胀不适或坠痛症状患者中,术后症状完全消失的患者23例（85.19％）,症状减轻者3例（11.11％）,无明显改善者1例（3.70％）.随访期间未见复发病例.所有患者术前与术后随访各个月精液参数比较,精液量无显著性变化（P＞0.05）;而精子密度、精子总数、a级运动精子率、a＋b级活动精子百分率以及正常形态精子率在术后随访各个月较术前均有明显提高（P＜0.05）.比较术后随访各个月精液参数,精子密度、精子总数、a＋b级活动精子百分率、a级运动精子率以及正常形态精子率在术后3个月较术后1个月均有明显改善（P＜0.05）,而术后6个月较术后3个月均无显著性差异（P＞0.05）.结论 腹腔镜下精索静脉高位结扎术能安全有效的治疗精索静脉曲张不育患者,同时能显著提高不育患者精子质量,且在术后3个月患者精子质量改善达到相对稳定.Objective To explore the clinical efficacy of laparoscopic varicocele high ligation for male infertile patients and the changes in semen quality after surgery.Methods The records and database of 60 patients with sterility in our hospital between January 2012 and June 2015 who underwent laparoscopic varicocele high ligation were reviewed retrospectively.Among them,27 cases had scrotum discomfort or bearing-down pain.All of them had been followed regularly in postoperative 1,3,6 months as well as semen testing respectively.The clinical symptomatic remissions and postoperative complication in all patients and identify the changes in semen quality after surgery were observed.Results In all 60 cases,scrotum emphysema occurred in 5 （8.33%） patients and only one patient presented scrotum edema （1.67%） and these complications disappeared in the initial visit.Twenty seven patients who have clinical symptoms,23 （85.19%） patients＆#39; symptoms disappeared,3 patients＆#39; （11.11%） symptoms relieved,only 1 patient（3.70%） didn＆#39;t respond in the last visit.There were no recurrence during the six-month follow-up period.Postoperative sperm quality index of sperm density,sperm motility （a）,sperm motility （a ＋ b）,total sperms,normal sperm morphology rate were significantly beyond than before surgery and the results were statistically significant（P 〈0.05）,but there was no statistically significant difference in semen volume before and after operation （P 〉0.05）.Semen parameters at postoperative 3 months had been improved obviously compared with at postoperative 1 month except semen volume（P 〈 0.05） and there was no statistical difference in all semen parameters between postoperative 3 months and postoperative 6 months （P 〉 0.05）.Conclusions Laparoscopic varicocele high ligation can be safe and effective in the treatment of patients with varicocele with infertility and significantly improve postoperative semen parameters.Semen quality is improved to meet a relatively stabl

关 键 词：精索静脉曲张 腹腔镜 结扎术 精子 

分 类 号：R699.8[医药卫生—泌尿科学]