腹腔镜下与显微镜下精索静脉结扎术后12个月生育力比较  

Comparison of 12-month Fertility after Laparoscopic and Microscopic Spermatic Vein Ligation

作　　者：毛军 程鹏 潘彩明[1] MAO Jun;CHENG Peng;PAN Caiming(Department of Urology,Yijishan Hospital,Wannan Medical College,Wuhu,Anhui Province,241000 China)

机构地区：[1]皖南医学院弋矶山医院泌尿外科,安徽芜湖241000

出　　处：《系统医学》2022年第18期10-14,共5页Systems Medicine

基　　金：安徽省卫生健康委科研项目(AHWJ2021b122)。

摘　　要：目的比较腹腔镜下与显微镜下精索静脉结扎术后12个月生育力。方法将皖南医学院弋矶山医院2018年7月—2021年3月确诊为精索静脉曲张伴男性不育患者106例依据精液分析结果分为轻度少弱精子症(A组,74例)和中-重度少弱精子症(B组,32例),再将A、B各组按照1∶1的比例随机分配进入腹腔镜下精索静脉高位结扎术组(LS组)、显微镜下精索静脉低位结扎术组(MS组),各53例,其中A组中LS组、MS组各37例,B组中LS组、MS组各16例。统计分析各组手术前后精液质量、血清生殖激素水平,并统计分析各组术后配偶受孕情况。结果术A各组精子密度、A+B级活动力精子数、精子总数较术前明显提高,且MS组均高于LS组,差异有统计学意义(P<0.05)。A组术后血清FSH、LH均低于治疗前,差异有统计学意义(P<0.05);MS组血清T水平低于LS组,血清LH水平均高于LS组,差异无统计学意义(P>0.05);而血清FSH高于LS组,差异有统计学意义(P<0.05)。A组:MS组配偶自然怀孕9例,LS组配偶自然怀孕2例,MS组配偶自然怀孕率24.32%高于LS组5.41%,差异有统计学意义(χ2=5.232,P<0.05);B组:MS组、LS组配偶均未自然怀孕,差异无统计学意义(P>0.05)。结论显微镜下与腹腔镜下精索静脉结扎术均可改善患者的睾丸功能及精液参数;显微镜下精索静脉结扎术对于轻度弱精子症患者精液质量恢复更佳,可提高受孕率;对于中-重度弱精子症患者,两种术式均无法改善患者精液质量。Objective To compare the 12-month fertility after laparoscopic and microscopic spermatic vein ligation.Methods A total of 106 cases of varicocele with male infertility diagnosed in Yijishan Hospital,Wannan Medical College from July 2018 to March 2021 were divided into mild oligoasthenospermia(group A,74 cases)and moderate to severe oligoasthenosis spermia(group B,32 cases)according to the results of semen analysis.Then groups A and B were randomly assigned to each group according to the ratio of 1∶1 to the laparoscopic high spermatic vein ligation group(LS group)and the microscope low spermatic vein ligation group(MS group),with 53 cases in each group.Among them,there were 37 cases in the LS group and 37 cases in the MS group in the A group,and 16 cases in the LS group and the MS group in the B group.The semen quality and serum reproductive hormone levels before and after surgery in each group were statistically analyzed.The post-operative spouse pregnancy in each group was also statistically analyzed.Results The sperm density,A+B motile sperm count and the total sperm count in A group after operation were significantly higher than those before operation,and the MS group was higher than the LS group,the difference was statistically significant(P<0.05).The serum FSH and LH of A group after operation were lower than those before treatment,the difference was statistically significant(P<0.05);the serum T level in MS group was lower than that in LS group,and the levels of serum LH were higher than those in the LS group,the difference was not statistically significant(P>0.05);the serum FSH was higher than that of LS group,the difference was statistically significant(P<0.05).Group A:9 cases of spouses in the MS group and 2 cases in the LS group became pregnant naturally,the natural pregnancy rate of the spouses in the MS group was 24.32%higher than that in the LS group(5.41%),the difference was statistically significant(χ2=5.232,P<0.05);group B:The spouses of the MS group and the LS group were not naturally pregnant,

关 键 词：腹腔镜 显微镜 精索静脉结扎术 术后12个月生育力 精液质量 生殖激素 

分 类 号：R69[医药卫生—泌尿科学]