显微镜下精索静脉曲张修复术改善精子质量降低辅助生殖技术级别的临床研究  

Microscopic repair of varicocele improves sperm quality and reduces the level of assisted reproductive technology

作　　者：孙建华 周梁 季兴哲 张洲 师娟子 邢俊平[2] SUN Jianhua;ZHOU Liang;JI Xingzhe(Center of Asisted Reproductive Technology,Northwest Women and Children’s Hospital(Xi’an 710003))

机构地区：[1]西北妇女儿童医院生殖中心,西安710003 [2]西安交通大学第一附属医院泌尿外科,西安710061

出　　处：《陕西医学杂志》2019年第5期561-563,568,共4页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(81771657);西安市科技局基金资助项目[2016052SF/YX08(1)]

摘　　要：目的:探讨显微镜下精索静脉曲张修复术治疗男性不育精液质量改善的程度,以及是否可以降低需要试管婴儿或者人工授精的夫妇辅助生殖技术的级别。方法:回顾性分析确诊为左侧精索静脉曲张,接受了显微镜下精索静脉曲张修复术的男性不育患者。按照男性前向运动精子总数的评估标准分为三组:自然妊娠组(NP组)>40×10~6;人工授精组(IUI组)(30～40)×10~6;试管婴儿组(IVF组)(10～30)×10~6。分析比较术前术后的前向运动精子总数的情况。结果:总共137例患者接受了显微镜下精索静脉曲张修复术。术前术后比较:137例总体前向运动精子总数[(40.33±20.56)×10~6与(57.89±30.67)×10~6](P<0.05);IVF组术前术后比较:[(11.24±32.45)×10~6与(35.67±23.45)×10~6](P<0.05),有52.94%的患者无需试管婴儿治疗,改为人工授精或者尝试自然受孕;IUI组术前术后比较:[(35.33±18.48)×10~6与(50.43±23.67)×10~6](P<0.05),有58.33%的患者尝试自然受孕;建议自然妊娠组活动精子总数术前术后显著增加[(46.26±28.36)×10~6与(67.89±32.47)×10~6](P<0.05)。结论:显微镜下精索静脉曲张修复术在男性不育治疗中具有重要的作用,可以增加前向运动精子的总数。显微镜下精索静脉曲张修复术可以减少不育症夫妇对IVF或IUI的需要,降低辅助生殖技术的级别。Objective:To investigate the extent to which microscopic varicocele repair improves semen quality in infertile men and whether it can reduce the level of assisted reproductive technology in couples requiring IVF or IUI.Methods:A retrospective analysis was made of male infertility patients who were diagnosed as left varicocele and underwent microsurgical varicocele repair.According to the evaluation criteria of the total number of male forward motile sperm in assisted reproductive technology(ART)of Northwest Women’s and Children's Hospital,they were divided into three groups:natural pregnancy group(NP)>40 million,artificial insemination group(IUI)30~40 million,and In vitro fertilization(IVF)10~30 million.The total number of forward motile sperm before and after operation was analyzed and compared.Results:A total of 137 patients underwent microscopic varicocele repair.The total number of forward motor sperm was compared before and after operation in 137 cases[(40.33±20.56)vs(57.89±30.67)](P<0.05).Compared with preoperative and postoperative IVF group[(11.24±32.45)vs(35.67±23.45)](P<0.05),52.94% of the patients did not need IVF treatment,but changed to artificial insemination or attempted natural pregnancy.In the artificial insemination group[(35.33±18.48)vs(50.43±23.67)](P<0.05),58.33% of the patients tried to conceive naturally before and after operation.It is suggested that the total number of motile sperm in natural pregnancy group increase significantly before and after operation[(46.26±28.36)vs(67.89±32.47)](P<0.05).Conclusion:Microscopic varicocele repair plays an important role in the treatment of male infertility,which can increase the total number of motile sperm.Microscopic varicocele repair can reduce the need for IVF or IUI in infertile couples and reduce the level of assisted reproductive technology.

关 键 词：男性不育 显微镜下精索静脉曲张修复术 精液 辅助生殖技术 宫内受精 体外受精 

分 类 号：R717[医药卫生—妇产科学]