经外环下精索静脉结扎术与腹股沟显微精索静脉结扎术对精索静脉曲张患者的精液质量及性激素水平的影响

摘要 目的：对比分析经外环下精索静脉结扎术与腹股沟显微精索静脉结扎术对精索静脉曲张患者的精液质量及性激素水平的影响。方法：113例研究对象,随机分为观察组（n=57）和对照组（n=56）,对照组给予腹股沟显微精索静脉结扎术,观察组给予经外环下精索静脉结扎术,对比其精液质量、性激素水平以及并发症发生率。结果：术后半年,两组患者精子密度等相关指标均显著提高,且观察组均较对照组高（P＜0.05）;两组患者术后血清促卵泡激素（follicle-stimulating hor-mone,FSH）、血清睾酮（testoster-one,T）、黄体生成素（luteinizing hormone,LH）浓度水平比较,观察组显著较对照组低（P<0.05）,术后血清T水平显著升高,观察组显著高于对照组（P<0.05）;两组患者术后2周内并发症发生情况比较,观察组低于对照组（P＜0.05）。结论：相比于腹股沟显微精索静脉结扎术,经外环下精索静脉结扎术更有利于患者精子质量的提高,改善性激素水平,降低患者并发症发生率,值得推广应用。     

显微外科与腹腔镜手术治疗精索静脉曲张疗效比较的回顾性研究

摘要 目的：对比显微外科与腹腔镜手术治疗索静脉曲张（VC）的临床效果。方法：回顾性分析2018年8月~2020年8月期间在我院接受精索静脉结扎术治疗的75例VC患者,其中接受腹腔镜手术的34例纳为A组,接受显微外科手术的41例纳为B组。观察两组手术及住院指标情况,对比两组手术前后精液质量变化,观察两组术后并发症发生率和复发率。结果：两组住院天数、住院费用组间对比差异无统计学意义（P>0.05）。B组手术时间长于A组,排气时间短于A组,组间对比差异有统计学意义（P<0.05）。手术后6个月,两组患者的精液量均增加,精子密度均增大,精子活率、活动精子总数均升高,精液液化时间均下降,且B组的变化程度大于A组（P<0.05）。B组的并发症发生率小于A组（P<0.05）。A组有2例患者随访期间复发,B组未见有患者复发,两组复发率组间对比差异无统计学意义（P>0.05）。结论：与腹腔镜手术治疗VC相比,显微外科手术能更有效地改善精液质量、缩短排气时间、降低并发症发生率,虽然手术时间稍长,仍属于较为可靠的术式。     

三种不同手术方式治疗精索静脉曲张患者的临床研究

目的:研究三种不同的手术方式治疗精索静脉曲张患者(VC)的临床疗效。方法:选择2015年1月至2017年6月在我院接受VC手术的患者128例进行研究,其中接受腹膜后高位结扎术者45例,纳入腹膜后组;接受腹腔镜手术者39例,纳入腹腔镜组;接受显微手术者44例,纳入显微手术组,对比各组患者的手术时间、出血量、住院时间及住院总费用,对比术前、术后3个月各组的睾丸体积、性激素水平,随访1年,记录各组复发率和并发症发生情况。结果:显微手术组的手术时间长于腹膜后组与腹腔镜组,出血量、住院时间、住院总费用少于腹膜后组与腹腔镜组(P0.05)。术前、术后3个月各组左侧、右侧睾丸体积对比差异均无统计学意义(P0.05)。术后3个月各组睾酮(T)水平高于术前,卵泡刺激素(FSH)、黄体生成素(LH)水平低于术前(P0.05),术后3个月显微手术组T水平高于腹膜后组与腹腔镜组,FSH、LH水平低于腹膜后组与腹腔镜组(P0.05)。与腹膜后组、腹腔镜组相比,显微手术组的复发率及并发症发生率更低(P0.05)。结论:不同手术方案治疗VC均可获得一定的疗效,但显微术式可明显改善性激素水平,降低复发率及并发症发生率,术后恢复好,费用少。     

精索静脉曲张结扎术改善精液质量效应的Meta 分析

目的:对于精索静脉曲张结扎术在改善精液质量中的效应进行Meta分析,明确不同手术方式是否具有改善精液质量的作用及其程度,对精索静脉曲张导致男性不育手术治疗的决策提供参考依据。方法:计算机检索MEDLINE(1985~2011.10)、EMbase(1990~2011.10),中国生物医学文献光盘数据(1979~2011.10),中国生物医学期刊文献数据库(CMCC,1979~2011.10)、CNKI数字图书馆(1990~2011.10),手工检索《中国男科学》等四种相关杂志,纳入研究精索静脉曲张结扎术对改善精液质量效应的临床随机对照实验,两名分析人员独立进行文献筛查,质量评价和数据提取,并相互核对,有分歧时通过向专家咨询并改进检索策略后解决。RevMan 4.3.1软件用于Meta分析。结果:初步检出256篇文献,经过筛选纳入8篇随机对照实验,患者1472例。通过Meta分析显示,腹腔镜下结扎术,腹膜后小切口结扎术,经腹股沟管结扎术和腹股沟下显微结扎术均可改善精液参数。腹腔镜下结扎术可使精子活率提高11.70%,95%可信区间(95%CI)[7.32,16.08],P<0.00001,精子密度提高20.68×106/mL,95%CI为[15.01,26.43],P<0.00001,降低精子畸形率15.69%,95%CI为[-18.16,-13.22],P<0.00001。腹膜后小切口结扎术使精子活率提高13.35%,95%CI[5.28,21.43],P<0.00001,密度提高11.20×106/mL,95%CI为[1.65,20.75],P<0.00001,降低畸形率16.44%,95%CI为[-19.29,-13.60],P<0.00001。经腹股沟管结扎术使活率提高10.76%,95%CI[8.79,12.72],P<0.00001,精子密度提高11.24×106/mL,95%CI为[3.25,19.22],P<0.00001,降低畸形率15.01%,95%CI为[-15.75,-14.27],P<0.00001,提高精子正常形态率1.99%,95%CI为[1.07,2.91],P<0.00001。腹股沟下显微结扎术使精子活率提高12.99%,95%CI为[9.81,16.18],P<0.00001,密度提高17.20×106/mL,95%CI为[7.68,26.71],P<0.00001,降低畸形率6.73%,95%CI为[-12.77,-0.68],P<0.00001。结论:患有精索静脉曲张的男性不育症患者经过手术治疗可以有效改善精液分析参数,对于提高精子活率,密度及降低畸形率具有一定疗效。     

彩色多普勒超声检测睾丸微石症合并精索静脉曲张患者睾丸动脉与精索静脉血流动力学的临床分析

目的:采用彩色多普勒超声检测睾丸微石症(TM)合并精索静脉曲张(VC)患者睾丸动脉与精索静脉血流动力学的情况,并分析VC分级与TM分型的关系。方法:选择2014年8月到2016年8月80例TM合并VC患者及80例健康男性分别作为研究组与对照组,均采用彩色多普勒超声检测睾丸动脉收缩期峰值血液速度(PSV)、阻力指数(RI)及精索静脉最高流速(VS-Vmax)、静脉返流时间(TR)、平静呼吸最大内径(DR)、Valsalva试验最大内径(DV)。用Spearman秩相关分析TM分类与VC评分的关系。结果:两组睾丸动脉RI比较无显著差异(P0.05)。研究组PSV明显小于对照组(P0.05),精索静脉DR、DV、VS-Vmax、TR均显著大于对照组(P0.05)。TM分类与VC分级呈正相关(P0.05)。结论:TM合并VC患者睾丸动脉、精索静脉血流动力学均存在不同程度的改变,VC严重程度与睾丸微小结石数量呈正相关。     

Testosterone amplifies HSP70-2a,HSP90 and PCNA expression in experimental varicocele condition: Implication for DNA fragmentation

The DNA fragmentation and failure in post-meiotic maturation of the spermatozoa because of testosterone withdrawal can affect the fertilization potential in varicocele (VCL) patients. To find out the exact mechanism of VCL-induced failure in histone-protamine replacement process and DNA fragmentation, the correlations between the levels of expression of HSP70-2a, HSP90, PCNA, TP1/2 and PCNA genes and the patterns of DNA methylation were investigated before and after testosterone administration in rats. In total, 40 mature male Wistar rats (10 in each group) were assigned between control (with no intervention), control-sham (undergone a simple laparotomy), VCL-induced (VCL-sole), and testosterone-treated VCL-induced (VCLT) groups. The HSP70-2a, HSP90, PCNA, TP1, and TP2 genes expressions and the patterns of global DNA methylation were determined in all groups. A statistically significant (p < 0.05) reduction were found in the HSP70-2a, HSP90, PCNA, TP1 and TP2 genes expressions in VCL-sole group. In VCLT group, testosterone was shown to significantly (p < 0.05) up-regulate the HSP70-2a, HSP90, PCNA, and TP2expression levels, but TP1 expression has not been changed. Furthermore, the VCLT group exhibited higher DNA methylation rates compared to VCL-sole animals. In conclusion, testosterone, by up-regulating the HSP70-2a and HSP90 expressions and maintaining the pre-existing HSP70-2a and HSP90 proteins levels, may be the reason for the significant increment in TP2 expression during post-meiotic stage and can boost the global methylation rates of DNA via up-regulating the PCNA expression, suggesting that administration of testosterone can mitigate the VCL-impaired histone-protamine replacement and DNA methylation rates and protect the cellular DNA content from VCL-induced oxidative stress.     

超氧化物歧化酶和Bcl-2在实验性精索静脉曲张大鼠睾丸中的变化

目的:建立大鼠实验性精索静脉曲张(experimental varicocele EV)的模式,测量睾丸中超氧化物歧化酶(superoxide dismutaseSOD)活性和Bcl-2的表达。方法:将40只雄性青春期Wistar大鼠随机分为EV8周组和12周组(各12只)和相应的假手术对照组2组(各8只),通过部分结扎左肾静脉建立大鼠EV模型,分别于术后8周、12周处死动物,测左侧精索静脉直径,用比色法测SOD 活力,免疫组化法测Bcl-2的表达。结果:成功建立了EV型,与相应的对照组相比左侧精索静脉直径明显增大(P<0.01)。光学显微镜下观察睾丸组织,发现大鼠睾丸生精上皮退变,曲细精管萎缩,间质水肿和精子发育阻滞。EV组双侧睾丸的SOD活性显著低于相应的对照组(P<0.01),左侧睾丸比右侧睾丸更低,但无明显统计学意义(P>0.05)。EV组双侧睾丸间质细胞中Bcl-2的染色指数与相应的对照组相比均显著降低(P<0.01),左侧睾丸染色指数比右侧睾丸下降更明显(P<0.01),EV12周组与 EV8周组相比,EV12周组染色指数更低(P<0.05)。SOD活性与Bcl-2的染色指数在0.01水平有显著相...     

精索静脉曲张导致不孕机制及治疗分析

精索静脉曲张(VC)是男性尤其是生育期男性常见的一种泌尿生殖系统疾病。WHO已将VC作为引起男性不育的首要原因。但目前的研究仍然没有明确其发病机制,因此探讨精索静脉曲张致男性不育的机制具有重要意义。其发病机制虽不明确,但手术治疗可以明确改善VC患者的不孕状况。这个结论已在临床上得到了大多数学者的认可。     

An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients

Varicocele is one of the main and surgically repairable causes of male infertility, which arises from dilatation and torsion of the testicular veins in the plexus pampiniformis. In this study, we examined semen samples from 40 patients diagnosed with varicocele between the ages of 15 and 30 years, according to WHO criteria (pre-operatively, and at 3, 6, and 12 months post-operatively). The mean spermatozoa concentration was found to be 45.25?±?34.83 million/ml pre-operatively, while the mean post-operative concentration was 48.85?±?35.73 million/ml at three months, 51.72?±?32.82 million/ml at six months, and 49.63?±?28.05 million/ml at 12 months (P?>?0.05). The mean rate of A?+?B motile spermatozoa was 35.5?±?14.71% pre-operatively, 42.65?±?16.80% at three months, 43?±?13.52%at six months and 44?±?14.76 percent at 12 months post-operatively (P?<?0.05). The mean Kruger morphology score was 3.15?±?3.0% pre-operatively, and 3.20?±?2.83% at three months, 2.97?±?2.61%at six months and 3.27?±?2.50%at 12 months post-operatively (P?>?0.05). The nucleus, acrosomal cap, mitochondrial structure and microtubules of the tail of the spermatozoa were examined under electron microscopy. The mean DNA fragmentation index (DFI%) of the spermatozoa was 20.57?±?4.60% pre-operatively, and post-operatively at 17.27?±?3.65% at three months, 15.5?±?3.23% at six months and 15.3?±?3.63% at 12 months (P?<?0.001).The findings suggest that despite the increased count and motility, as well as the improved DNA fractures observed post-operatively in the spermatozoa of varicocele patients, the morphology rates remain intact.