MSV术与开放手术治疗精索静脉曲张性不育症效果及对患者FSH、LH、T水平影响  

Effect of microsurgery via inferior inguinal spermatic vein ligation and open surgery for treating infertility patients because of varicocele and their influence on FSH,LH and T levels

作　　者：肖戈 尹杰[1] 陈向新[1] 何国伟[1] 吴亚斌 林靖波[1] 陈清标 XIAO Ge;YIN Jie;CHEN Xiangxin;HE Guowei;WU Yabin;LIN Jingbo;CHEN Qinbiao(Foshan Second People's Hospital, Guangdong, 528000)

机构地区：[1]广东省佛山市第二人民医院,528000

出　　处：《中国计划生育学杂志》2021年第2期319-323,共5页Chinese Journal of Family Planning

摘　　要：目的:观察显微镜经腹股沟下精索静脉结扎术(MSV)治疗精索静脉曲张性不育症的疗效及对患者精液卵泡刺激素(FSH)、黄体生成素(LH)、雄激素(T)水平影响。方法:回顾性收集2015年9月—2019年5月本院行手术治疗的206例精索静脉曲张伴不育症患者临床资料,根据手术方式将其分为开放组(传统精索静脉高位结扎开放手术,124例)和MSV组(MSV,82例)。比较两组手术治疗效果及手术前后精液FSH、LH、T水平变化。结果:MSV组手术时间(91.8±4.7min)长于开放组(57.1±4.7min),住院时间(3.7±0.5d)短于开放组(7.3±0.9d),其切口VAS评分(1.1±0.3分)小于开放组(7.5±1.7分)(P<0.05)。两组术后精子密度、精力活力、精子活率、精子正常率及A+B级活力精子率较手术前均升高,且MSV组均高于开放组(P<0.05)。MSV组睾丸动脉识别率、精液质量改善率均高于开放组,睾丸鞘膜积液、阴囊水肿发生率和静脉曲张复发率均低于开放组(P<0.05)。两组术后精液FSH、LH较术前均降低、T升高,且MSV组改善幅度优于开放组(P<0.05)。术后1~12个月累计妊娠率MSV组(73.2%)高于开放组(46.8%)(P<0.05)。结论:MSV术治疗精索静脉曲张伴不育症能显著改善患者精子质量和生殖内分泌激素失调,虽然其手术时间较长,但具有对动脉识别率高,术后并发症少,住院时间短,切口疼痛轻,术后1年内配偶妊娠率高等优点,值得临床推广应用。Objective:To observe the efficacy of via inferior inguinal microscopic spermatic vein ligation(MSV)for treating infertility patients because of varicocele,and to study its influence on their levels of reproductive hormone follicle stimulating hormone(FSH),luteinizing hormone(LH),and androgen(T).Methods:206 infertility patients because of varicocele from September 2015 to May 2019 were collected retrospectively,and were divided into group A(124 patients with traditional high ligation of spermatic vein)and group B(82 patients with MSV).The operative effect and the changes of FSH,LH and T levels in semen before and after operation of the patients were compared between the two groups.Results:The operative time(91.8±4.7min)of the patients in group B was significant longer than that(57.1±4.7min)of the patients in group A,but hospital stay(3.7±0.5d)of the patients in group B was significant shorter than that(7.3±0.9d)of the patients in group A,and the incision VAS score(1.1±0.3 points)of the patients in group B was significant less than that(7.5±1.7 points)of group A(P<0.05).Sperm density,sperm vitality,sperm motility,normal sperm rate,and A+B grade motility sperm rate of the patients in both groups had increased significantly after operation,and those of the patients in group B were significant higher than those of the patients in group A(P<0.05).The testicular artery recognition rate and semen quality improvement rate of the patients in group B were significant higher than those of the patients in group A,but the incidences of testicular hydrocele,scrotal edema,and the recurrence of varices testicular hydrocele,the incidence of scrotal edema and the recurrence rate of varicose veins of the patients in group B were significant lower than those of the patients in group A(P<0.05).The postoperative levels of LH and T in semen of the patients in both groups had decreased significantly,but postoperative T level in semen of the patients in both groups had increased significantly,which’s improvement degree of the pati

关 键 词：男性不育 精索静脉曲张 显微镜下精索静脉结扎术 精液质量 精液生殖激素 

分 类 号：R698.2[医药卫生—泌尿科学]