手术配合高压氧治疗精索静脉曲张不育患者的临床研究

目的:探讨手术配合高压氧(HBO)治疗精索静脉曲张(VC)所致不育的临床疗效及机制。方法:将VC不育患者96例随机分成两组,A组(40例)为手术配合高压氧治疗组,B组(56例)为单纯手术组。结果:两组在精子密度、精子活率、精子活力和正常形态精子数、睾酮、配偶受孕率方面都有显著改善(P<0.01或P<0.05),且A组改善优于B组(P<0.05)。A组患者卵泡刺激素、黄体生成素在治疗后较治疗前显著下降(P<0.05)。A组精子穿透卵子百分率(SPA值)改善优于B组(P<0.05)。A组治疗后配偶受孕时间较B组提前(P<0.05)。结论:手术配合HBO治疗VC不育患者较单纯手术治疗更有效改善生殖内分泌激素失调,提高精子质量,提高SPA值,增加受孕率,缩短治疗后受孕时间。     

手术治疗精索静脉曲张87例临床观察

目的 探讨精索静脉曲张传统手术的效果及价值.方法 采用局部浸润麻醉或椎管内麻醉,回顾性分析87例常规精索内静脉高位结扎术的治疗效果及恢复情况.结果 87例手术均获得成功,平均手术时间23 min,术中未见明显出血及脏器损伤,术后平均住院5.4 d.随访78例,时间2～18月,4例(5.1%)复发,无1例发生睾丸萎缩或坏...     

精索静脉曲张不育患者的精液质量和精子形态学观察

目的:观察不育伴精索静脉曲张(VC)患者的精液质量和精子形态学变化。方法:98例不育伴VC患者精液按WHO标准常规分析并对精子形态学进行评价。130例正常供精者精液检测结果作为对照。结果:VC患者正常形态精子和前向运动精子明显低于对照组(P<0.001),精子畸形的类型以梨形、锥形和不定型头部畸形为主。结论:VC可导致精子畸形率升高,后者可能是男性生育力受损的重要标志之一,经染色后的精子形态学分析是判定VC患者精子受损的一个敏感指标。     

显微镜下精索内静脉高位结扎术对精索静脉曲张患者精液质量的影响

目的 探讨显微镜下精索内静脉高位结扎术在精索静脉曲张患者治疗中的临床效果。方法 回顾性收集2019年10月至2022年10月期间收治的86例精索静脉曲张患者,根据术中采用的手术方式划分为观察组（显微镜下精索内静脉高位结扎术）43例和对照组（腹腔镜下精索内静脉高位结扎术）43例,比较分析两组数据指标。结果 观察组患者手术时间（103.47±12.42） min较对照组长（82.73±9.81） min,差异显著（P<0.05）;观察组住院时间（4.58±0.75） d较对照组（6.12±0.84） d短,差异有统计学意义（P<0.05）;观察组患者精子浓度（46.41±5.72） 106/mL、精子活动率（67.87±6.94%）和精子存活率（75.73±7.89%）均较对照组明显升高（42.81±5.33） 106/mL、（62.84±6.25）%和（66.43±7.04）%,差异有统计学意义（P<0.05）;观察组患者精液量（4.22±0.58） mL较对照组（3.79±0.47） mL多,差异有统计学意义（P<0.05）;观察组术后发生阴囊水肿1例、鞘膜积液...     

精索静脉曲张不育患者精浆生化分析

目的探讨精索静脉曲张(VC)不育患者的精浆生化变化.方法分别检测168例VC不育患者(VC不育组)和随访到的该组89例精索静脉高位结扎术后患者及40例正常生育男性(对照组)的精浆中酸性磷酸酶、果糖、锌、肉毒碱和α-糖苷酶含量.结果 VC不育组与正常生育对照组两组间酸性磷酸酶含量差异无统计学意义(P>0.05);两组间果糖含量差异无统计学意义(P>0.05);两组锌的含量比较差异有统计学意义(P<0.05);两组间α-糖苷酶及肉毒碱含量比较差异有统计学意义(P<0.01).术后和术前酸性磷酸酶含量及果糖比较差异无统计学意义(P>0.05);锌、α-糖苷酶及肉毒碱含量比较,差异有统计学意义.结论 VC可通过某些因素引起精浆中锌、α-糖苷酶和肉毒碱含量降低,从而造成男性不育.     

精索静脉曲张不育患者精子形态学分析及其治疗后的初步观察

应用改良巴氏染色法对５４例精索静脉曲张不育患者的精子形态学进行了分析并初步观察治疗后的效果。结果表明，精索静脉曲张Ⅰ度组、Ⅱ度组和Ⅲ度组的精子畸形率均显著高于正常生育力组（Ｐ＜０．０１），而且尖头精子、顶体异常、老化精子和不定形精子数都有较高的比率。经手术治疗后，初步观察到Ⅱ度组的精子畸形率显著减少（Ｐ＜０．０１），但是Ⅲ度组却无显著变化（Ｐ＞０．０５）。提示①精索静脉曲张导致不育的原因之一是正常     

精索静脉曲张不育患者手术前后血浆性激素变化

将６４例单纯精索静脉曲张源性不育患者随机分为手术组３３例与非手术组３１例，分别于术前及术后６个月测血浆卵泡刺激素（ＦＳＨ）、黄体生成素（ＬＨ）、睾酮（Ｔ），同时测４６名正常生育力男性性激素作为正常值对照，对两组不育患者还进行了睾丸体积测定和精液分析。手术组采用经髂窝腹膜外单纯精索内静脉高位结扎术。结果：６４例精索静脉曲张源性不育患者精子密度、精子存活率、睾丸体积低于正常组，ＦＳＨ、ＬＨ、Ｔ均在正常值范围，与正常组对照无明显差异。两组手术前后对照分析，手术组与非手术组手术前后血浆性激素虽无统计学差异，但手术组患者术后精液质量、睾丸体积明显改善，随访一年手术组妊娠率（２７％）显著高于非手术组（１３％）。术前ＦＳＨ较高的患者术后精液质量、睾丸体积无明显改善，而术前ＦＳＨ正常者有显著差异。认为，精索静脉曲张不育患者通过手术治疗确能提高其生育能力，而术前根据血浆ＦＳＨ、ＬＨ、Ｔ测定结合睾丸检查、精液分析可以初步估计睾丸受损程度，对手术预后的判断有一定参考价值。     

低位显微外科与腹腔镜两种精索静脉结扎术治疗精索静脉曲张性不育疗效比较

目的 比较低位显微外科与腹腔镜精索静脉结扎术治疗精索静脉曲张性不育患者的疗效.方法 40例精索静脉曲张性不育患者,随机分为两组,低位显微外科精索静脉结扎术组(A组,20例)和腹腔镜精索静脉结扎术组(B组,20例),比较术前、术后第1、6、12月的精液质量,并且追踪术后2年内配偶临床妊娠结果.结果 两组术后精子密度、精子总数和(a+b)级精子数均较术前有显著提高(P<0.05),但组内术后第1、6、12月的精液质量各主要参数间对比,无统计学差异(P>0.05).组间术前、术后第1、6、12月精液质量各主要参数进行对比,无统计学差异(P>0.05).术后随访2年配偶临床妊娠A组为13例(65%),B组为12例(60%).结论 低位显微外科精索静脉结扎术对精索静脉曲张(VC)伴有男性不育患者是一种经济、简单、有效、便于推广的手术治疗方式.     

精索静脉曲张手术的指征

精索静脉曲张(Varecocle,VC)是指精索蔓状静脉丛因各种原因引起回流不畅或因静脉瓣损坏引起血液倒流而形成局部静脉扩张、迂曲、伸长的病理现象.对于VC患者,大部分医生支持手术治疗,他们认为VC是男性不育的一个主要原因,通过治疗可以显著提高患者生育水平[1].那么对于所有诊断为VC的患者,是否都需要进行手术治疗?青少年VC患者和成年VC患者在治疗上有何不同?亚临床VC患者,是否需要进行手术干预?目前意见尚未统一,本文拟通过对文献回顾,就VC的手术指征作一个综述.     

手术配合中药治疗精索静脉曲张引起的男性不育症

精索静脉曲张是造成男性不育的原因之一,采用精索静脉高位结扎术治疗有一定疗效.为了进一步提高术后精液质量改善率和怀孕率,我们对该类不育症在手术的基础上加用中药治疗,收到较好效果,报告如下.     

Radiologically assessed testicular changes in infertile males with varicocele

The aim of this study was to assess vascular disturbances in the testis of infertile males associated with varicocele. In total, 124 consecutive male subjects were divided into the following groups: healthy fertile controls (n = 10), Gp1 (n = 28); infertile males with subclinical varicocele, Gp2 (n = 26); infertile males with grade I left varicocele, Gp3 (n = 28); infertile males with grade II left varicocele and Gp4 (n = 32); infertile males with grade III left varicocele. They were subjected to colour duplex for pampiniform plexus and scrotal scintigraphy. There was significant decrease in arterial blood velocity, testicular arterial diameters and testicular perfusion especially in high grade varicocele compared with healthy controls. The mean vein diameter demonstrated significant negative correlation with arterial diameter, arterial blood velocity, perfusion index, testicular size and significant positive correlation with perfusion index. The mean testicular size demonstrated significant positive correlation with arterial blood velocity, perfusion index and nonsignificant correlation with arterial diameter. It is concluded that there are significant decreases in testicular volume, testicular perfusion, blood velocity and testicular artery diameter in infertile males with varicocele.     

不育男性双侧Ⅰ度精索静脉曲张对睾丸体积和生殖激素水平的影响

目的 评价不育男性双侧I度精索静脉曲张对睾丸体积和生殖激素水平的影响.方法 185例不育男性双侧I度精索静脉曲张(A组)和149例正常生育男性(B组),比较其睾丸体积、卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)水平.结果 A组患者两侧睾丸体积均小于B组,但睾丸体积绝对差异和睾丸体积相对差异与B组比较,无统计学意义.A组患者血清FSH水平高于B组,而LH、T与B组相比,差异无统计学意义.结论 不育男性双侧I度精索静脉曲张可导致患者双侧睾丸体积减小,血清FSH水平升高.     

精索静脉曲张手术后精液变化的观察

目的观察精索静脉曲张手术后精液的变化,探讨手术的价值。方法使用计算机辅助分析检查48例病人精液中精子密度、畸形率、活率、A+B级精子比例。结果48例精索静脉曲张患者术后精子密度、存活率、A+B级精子比例较术前明显提高,畸形率明显下降,两组差别有显著性意义(P﹤0.05)。结论精索静脉曲张手术能改善精液的质量。     

The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters

Purpose

We studied the effect of varicocele ligation on Kruger strict morphology criteria and semen parameters in patients with infertility.

Materials and Methods

A total of 90 patients diagnosed with varicoceles and a normal morphological sperm ratio of less than 14% were evaluated before and 6 months after varicocelectomy. Preoperatively and postoperatively sperm density, motility and morphology using Kruger strict criteria were analyzed. The Wilcoxon test was used to measure levels of statistical significance in all analyses.

Results

Significant improvement in sperm concentration and motility was evident after varicocele ligation (p <0.0002 and <0.0001, respectively). Using the Kruger classification sperm morphology evaluation revealed a significant increase in the percent of normal forms, and of forms with head and acrosome defects (p <0.0001, <0.0014 and <0.0028, respectively). There were no concomitant changes in strict morphology in forms with mid piece and tail defects or immature forms (p >0.05). Of the 90 patients 18 (20%) achieved a successful full-term pregnancy, including 14 via natural cycle intercourse and 4 by intrauterine insemination.

Conclusions

Surgical correction of varicocele was associated with significant improvement in density, motility and sperm morphology evaluated using the Kruger classification.     

Spermatozoa protein alterations in infertile men with bilateral varicocele

Among infertile men, a diagnosis of unilateral varicocele is made in 90% of varicocele cases and bilateral in the remaining varicocele cases. However, there are reports of under-diagnosis of bilateral varicocele among infertile men and that its prevalence is greater than 10%. In this prospective study, we aimed to examine the differentially expressed proteins (DEP) extracted from spermatozoa cells of patients with bilateral varicocele and fertile donors. Subjects consisted of 17 men diagnosed with bilateral varicocele and 10 proven fertile men as healthy controls. Using the LTQ-orbitrap elite hybrid mass spectrometry system, proteomic analysis was done on pooled samples from 3 patients with bilateral varicocele and 5 fertile men. From these samples, 73 DEP were identified of which 58 proteins were differentially expressed, with 7 proteins unique to the bilateral varicocele group and 8 proteins to the fertile control group. Majority of the DEPs were observed to be associated with metabolic processes, stress responses, oxidoreductase activity, enzyme regulation, and immune system processes. Seven DEP were involved in sperm function such as capacitation, motility, and sperm-zona binding. Proteins TEKT3 and TCP11 were validated by Western blot analysis and may serve as potential biomarkers for bilateral varicocele. In this study, we have demonstrated for the first time the presence of DEP and identified proteins with distinct reproductive functions which are altered in infertile men with bilateral varicocele. Functional proteomic profiling provides insight into the mechanistic implications of bilateral varicocele-associated male infertility.     

Assessment of seminal granulysin in infertile men with varicocele

Varicocele has a common association with male infertility, but its exact role is still debated. Apoptosis has been suggested as one of the mechanisms of varicocele‐associated infertility. Granulysin is a molecule that plays a role in apoptosis with no previous study about its role in male infertility. This case‐controlled study aimed to assess seminal plasma granulysin level in infertile patients with varicocele. This study involved 90 men that were allocated into fertile normozoospermic men (n = 20), infertile men without varicocele (n = 30) and infertile men with varicocele (n = 40). These men were subjected to history taking, clinical examination, semen analysis and estimation of seminal granulysin. In general, seminal granulysin level was significantly elevated in infertile men compared with fertile men. Infertile men with varicocele showed significantly higher seminal granulysin compared with infertile men without varicocele, in bilateral varicocele cases and in grade III varicocele. Seminal granulysin level was negatively correlated with sperm concentration, sperm motility, sperm normal forms percentage and testicular volumes. It is concluded that increased seminal granulysin has a negative impact on spermatogenesis in infertile men in general and in infertile men associated with varicocele in particular.     

Assessment of seminal mast cells in infertile men with varicocele after surgical repair

This study aimed to assess seminal mast cells in infertile men associated with varicocele (Vx) pre‐ and post‐surgical repair. Forty‐five infertile men associated with Vx were subjected to history taking and clinical examination. In addition, semen parameters and seminal mast cells stained with 1% toluidine blue were estimated pre‐varicocelectomy and three months post‐varicocelectomy. Vx surgical repair revealed a significant improvement in the mean sperm concentration, progressive sperm motility, total sperm motility and sperm abnormal morphology and a significant decrement in seminal mast cells (mean ± SD, 3.56 ± 2.23 cells per high‐power field (HPF) vs. 2.22 ± 1.06 cells per HPF, p = .01). The pre‐operative mean mast cell count demonstrated significant increases in cases with Vx grade III compared with other Vx grades and in cases with bilateral Vx compared with unilateral Vx cases. Seminal mast cells demonstrated a significant correlation with sperm concentration, progressive sperm motility and total sperm motility and a nonsignificant correlation with age and sperm abnormal morphology. It is concluded that seminal mast cells decrease significantly in infertile men with Vx after surgical repair showing a significant negative correlation with sperm concentration, progressive sperm motility and total sperm motility.     

精索静脉曲张不育患者的精浆生化分析

目的 探讨精索静脉曲张不育患者精浆中酸性磷酸酶、果糖、锌和α-糖苷酶水平的变化.方法 分别检测120例精索静脉曲张不育患者、180例非精索静脉曲张不育患者和36例正常男性的精浆中酸性磷酸酶、果糖、锌和α-糖苷酶含量.结果 精索静脉曲张不育组和非精索静脉曲张不育组精浆中酸性磷酸酶含量均显著低于正常对照组（P＜0.01）,但精索静脉曲张不育组和非精索静脉曲张不育组之间的差异无显著性意义（P＞0.05）;各组精浆果糖活性无显著性差异（P＞0.05）;精浆中锌和α-糖苷酶含量随精索静脉曲张程度的增加而降低,且明显低于正常对照组（P＜0.05）,但与非精索静脉曲张不育组之间的差异无显著性意义（P＞0.05）.结论 精索静脉曲张可通过某些因素引起精浆中酸性磷酸酶、锌和α-糖苷酶含量降低,从而造成男性不育.     

精索静脉曲张男性不育患者Y染色体微缺失检测

目的:探讨精索静脉曲张(varicocele,VC)不育患者Y染色体微缺失特点及其与临床表型的关系,为评价VC不育患者是否行手术治疗或ICSI提供依据。方法:VC不育患者174例,分为3组,A组:无精子症47例;B组:严重少精子症57例;C组:轻度少精子症70例;设立正常生育的健康志愿者男性28例作为对照组(D组)。抽取外周血提取DNA,选取Y染色体上AZFa、AZFb、AZFc区共6个序列标签位点,应用多重PCR进行扩增;已生育女性26例作为阴性对照,分别运用琼脂糖凝胶电泳分离,对照阅读扩增产物,判定有无缺失存在以及缺失类型。结果:174例男性不育患者中有22例检测到Y染色体微缺失,缺失率12.64%;A组11例存在微缺失,B组11例存在微缺失,C组未检测到微缺失。A组与C组、B组与C组比较,差异均有显著性。A组缺失病例中有6例为AZFc区缺失,1例为AZFa缺失,2例为AZFb区缺失,2例为AZFb、AZFc区共同缺失;B组缺失病例中有8例为AZFc缺失,2例为AZFb缺失,1例为AZFb、AZFc区共同缺失。结论:①精液异常VC不育与Y染色体微缺失有关;②VC不育患者特别是无精子症和严重少精子症患者,应该进行Y染色体微缺失的检测。     

腹腔镜术与常规手术治疗精索静脉曲张不育症351例疗效观察

本文对３５１例精索静脉曲张不育症患者采用腹腔镜精索静脉结扎术（２４４例,其中１３例连同精索内动脉一并结扎）和经腹股沟精索静脉结扎术（常规手术,１０７例）,术后随访３～３２个月。在术后８周,两组精子计数、活动率、活动力均较术前有显著改善（Ｐ〈０．０１）。腹腔镜组精索内动脉结扎与否,其精子改善情况无显著差异（Ｐ〉０．０５）。两组相较,腹腔镜组术后精子计数、活动力的改善更为显著（Ｐ〈０．０１）。在术后１４周时,常规手术组精子计数仍明显低于腹腔镜组（Ｐ〈０．０５）。随访期间腹腔镜组妊娠者１４９例,妊娠率６１．０７％（其中动脉结扎者７例,妊娠率５３．８５％）,常规手术组妊娠者６２例,妊娠率５８．９３％,两组妊娠率无明显差异（Ｐ〉０．０５）。