腹膜后精索内静脉高位结扎术治疗精索静脉曲张性不育疗效分析

目的观察腹膜后精索内静脉高位结扎术治疗精索静脉曲张性不育患者的疗效。方法 150例精索静脉曲张性不育患者行腹膜后精索内静脉高位结扎术,比较术前、术后第3、6、12、24月的精液质量,并且追踪术后2年内配偶临床妊娠结果。结果术后精子密度、精子总数、a+b级精子数均较术前有显著提高(P<0.05),但术后第3、6、12、24月的精液质量各主要参数间对比,无统计学差异(P>0.05)。术后2年内配偶临床妊娠为90例(60%)。结论腹膜后精索内静脉高位结扎术治疗精索静脉曲张性不育疗效好,能改善患者的精液质量,提高其配偶的怀孕率。     

显微镜下小切口精索静脉高位结扎术治疗精索静脉曲张的临床效果观察

目的：与传统经腹股沟精索静脉结扎术,分析显微镜下小切口精索静脉高位结扎术对精索静脉曲张患者精液质量和术后妊娠和复发情况的影响。方法将60例精索静脉曲张患者按抽签法随机分成显微镜下高位小切口精索静脉高位结扎术（显微镜）组和传统经腹股沟精索静脉结扎术（传统）组,每组30例,比较两组术后的精液质量、复发率及配偶妊娠率。结果术后3个月,传统组精子浓度比术前明显提高;显微镜组精子浓度及总活力均较术前显著提高;显微镜组精子浓度高于传统组;差异均有统计学意义。术后6个月,两组精子浓度和总活力均较术前显著提高;显微镜组精子浓度显著高于传统组;差异均有统计学意义。术后妊娠率显微镜组高于传统组,复发率低于传统组。结论显微镜下小切口精索静脉高位结扎术效果优于传统经腹股沟精索静脉结扎术,是不育伴有精索静脉曲张患者的首选方法之一。     

经脐单孔无气腹腹腔镜下治疗精索静脉曲张性不育的效果观察

目的了解经脐单孔法无气腹腹腔镜精索静脉高位结扎术治疗精索静脉曲张性不育的临床疗效。方法选取精索静脉曲张患者40例,行经脐单孔法无气腹腹腔镜精索静脉高位结扎术,观察患者的手术时间、术后住院天数、术后并发症及术后3个月时精液质量改善情况。结果 40例患者术后均顺利完成,无明显出血影响手术操作,无严重手术并发症,术后阴囊坠胀不适感均消失或减轻,阴囊触诊扩张迂曲的静脉明显缩小,Valsava试验阴性。其中单侧患者手术时间为18~25 min,平均24.2 min;双侧患者手术时间为35~47 min,平均36.7 min。平均住院时间2.4 d。经过3个月随访,无复发病例,术后3个月复查精液常规,精液质量明显改善,术后精子密度、活率、（A＋B）级精子比例与术前比较差异有统计学意义（P〈0.05）。结论经脐单孔腹腔镜精索静脉高位结扎术可作为治疗精索静脉曲张性不育的一种可选术式,可取得良好的临床疗效。     

不育症伴精索静脉曲张两种术式疗效比较

目的观察显微镜下高位小切口精索静脉结扎术与传统经腹股沟精索静脉结扎术,对不育伴有精索静脉曲张患者精液质量的影响。方法60例男性不育症患者分成两组,各30例;分别行显微镜下高位小切口精索静脉结扎术（显微镜组）和传统经腹股沟精索静脉结扎术（传统术组）。比较两组患者术前、术后3月和6个月的精液质量及不育症复发情况。结果两组患者术后精液质量较术前都有较大的改善;显微镜组精液质量好于传统手术组。显微镜组不育症复发率明显低于传统手术组。结论显微镜下高位小切H精索静脉结扎术效果优于传统经腹股沟精索静脉结扎术,是不育伴有精索静脉曲张患者治疗的首选方法。     

精索静脉高位结扎术对抗精子抗体、精子顶体酶活性及精子数量、活动力的影响

目的探讨精索静脉曲张患者在精索静脉高位结扎术前、后精液中抗精子抗体、精子顶体酶活性及精子数量、活动力的变化。方法选取精索静脉曲张患者35例。用混合抗球蛋白凝集法(MAR)、改良的Kennedy法测定术前和术后3～6个月精液中抗精子抗体、精子顶体酶活性及精子计数、活动力(a及b级活动力精子的百分率)测定。结果精索静脉高位结扎术后患者精液中抗精子抗体有下降、精子顶体酶活性较术前明显增高、精子数量增加、活动力升高。结论精索静脉高位结扎术对精索静脉曲张患者精液中抗精子抗体的下降、精子顶体酶活性的提高、精液质量的提高有帮助。     

腹腔镜高位结扎精索静脉治疗精索静脉曲张的应用研究

目的探讨腹腔镜高位结扎治疗精索静脉曲张手术经验,分析精索静脉曲张病人的术后疗效及应用价值。方法回顾精索静脉曲张患者,实验组施行腹腔镜下精索静脉高位结扎术,对照组行腹膜后高位结扎术,对两组术后阴囊坠痛不适减轻、曲张精索静脉消失及精液质量改善进行分析比较。结果实验组较对照组在术后患侧阴囊坠痛,阴囊内曲张的精索静脉减缓或消失时间,及在术后复查精液常规,精子数及活动率均明显改善,两组疗效比较有统计学意义（P〈0．01）。结论腹腔镜下高位结扎精索静脉治疗精索静脉曲张,对机体创伤小、并发症少、术后恢复快,是一种安全可靠的手术方法,可作为手术治疗精索静脉曲张首选,值得临床大力推广。     

显微精索静脉结扎术治疗男性不育56例报告

目的探讨显微精索静脉结扎术治疗精索静脉曲张不育的临床效果。方法采用显微精索静脉结扎技术治疗56例精索静脉曲张不育患者,观察术前及术后1、3、12个月的精液质量并随访观察1年内配偶的妊娠率。结果56例患者术前精子浓度为（16．1±6．3）×10^6个／ml,术后1、3和12个月的精子浓度分别为（32．3±12．3）×10^6个／ml、（38．3±14．7）×10^6个／ml和（39．9±14．2）×10^6个／ml;术前精子总数为（54．2±18．3）×10^6个,术后1、3和12个月的精子总数分别为（112．5±48．8）×10^6、（125．7±47．7）×10^6和（126．7±49．5）×10^6个;术前前向运动精子总数为（7．3±1．5）×10^6个,术后1、3和12个月的前向运动精子总数分别为（53．8±9．0）×10^6、（66．2±10．2）×10^6和（68．3±11．9）×10。个,术后3项指标均有明显提高,与术前比较,差异均有统计学意义。术后随访1年妊娠率为60．7％。结论显微精索静脉结扎术可显著改善精索静脉曲张不育患者的精液质量,提高奸娠率。     

两种腹腔镜下手术方法治疗精索静脉曲张的临床体会

目的 探讨改良三孔三通道和经脐单孔腹腔镜下常规器械精索静脉高位结扎术治疗精索静脉曲张的可行性及临床疗效.方法 2006年7月至2010年4月收治的随访资料完整的Ⅱ度及以上原发性精索静脉曲张患者337例,其中采用改良三孔三通道腹腔镜下常规器械精索静脉高位结扎术249例(A组),采用经脐单孔腹腔镜下常规器械精索静脉高位结扎术88例(B组).比较两组手术时间、术后鞘膜积液发生率、睾丸萎缩率、复发率、精液质量提高率及2年内配偶自然妊娠率.结果 337例患者手术均获成功,B组手术时间为(19.0±7.5) min,明显短于A组的(38.0±10.9) min,差异有统计学意义(P＜0.05).A组和B组术后鞘膜积液发生率、睾丸萎缩率、复发率、精液质量提高率和术后2年内配偶自然妊娠率比较差异无统计学意义[ 0.4％(1/249)比0、1.2％( 3/249)比1.1％(1/88)、5.6％ (14/249)比4.5％(4/88)、77.1％(192/249)比79.5％(70/88)和56.9％(112/197)比61.8％(42/68),P＞0.05].结论 改良三孔三通道和经脐单孔腹腔镜下常规器械精索静脉高位结扎术治疗精索静脉曲张均安全有效,其中经脐单孔腹腔镜下常规器械精索静脉高位结扎术手术时间更短、手术创伤更小、手术切口更美观,可选择性开展应用.     

腹腔镜下精索静脉高位结扎术、改良Palomo术和经腹股沟管精索静脉结扎治疗精索静脉曲张的疗效对比

目的探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和经腹股沟管精索静脉结扎术治疗精索静脉曲张的疗效对比。方法回顾性分析2010年2月²014年2月期间在我院就诊的120例精索静脉曲张患者,其中行腹腔镜下精索静脉高位结扎术40例(腹腔镜组)、行改良Palomo术40例(改良组)、行经腹股沟管精索静脉结扎术40例(常规组),对比三组患者的手术时间、住院天数以及术后疗效。结果三组患者在手术时间、住院时间均无显著性差异(p>0.05),术后3个月、6个月时精液质量均较治疗前有显著改善(p<0.05),但三组组内比较3个月、6个月时精液质量无显著性差异(p>0.05)。而常规组患者手术复发率显著高于腹腔镜组和改良组(p<0.05)。结论精索静脉曲张患者采用腹腔镜下精索静脉高位结扎术、改良Palomo术和经腹股沟管精索静脉结扎术治疗均能取得较好的治疗效果,而对于双侧的曲张患者,建议选择腹腔镜手术。     

精索静脉高位结扎术治疗不同年龄患者的效果观察

目的:观察精索静脉结扎术对不同年龄精索静脉曲张患者的治疗效果。方法:采用前瞻性研究方法,对本院2008年9月-2015年6月收治的符合入选标准的原发性不育、精索静脉曲张患者130例,行精索静脉结扎术,术后6、12个月随访,分析≤35岁组及35岁组术前及术后精液参数变化并比较配偶受孕率。结果:术后两组患者精子浓度均显著升高;精子≥B级活动度精子比例≤35岁组由(37.6±5.5)%上升至(56.6±7.2)%,35岁组由(36.5±5.4)%上升至(54.3±6.4)%;异常精子形态比例≤35岁组由(72.7±4.3)%降至(59.3±5.8)%,35岁组由(71.6±5.9)%降至(58.5±7.2)%(均P0.05);两组间变化比较无差异(P0.05)。两组患者配偶受孕率(52.9%、46.8%)比较无差异(P=0.75)。结论:精索静脉结扎术在改善不同年龄患者的精液参数及配偶受孕率方面未见明显差异。     

EXPRESSION OF LECTIN RECEPTORS ON THE MEMBRANE SURFACE OF SPERM OF FERTILE AND SUBFERTILE BOARS BY FLOW CYTOMETRY

66 nonobstructive azoospermic men with normal genetic analysis composed of 32 (48%) patients with and 34 (52%) patients without varicocele were evaluated for the rate of sperm extraction five months after the varicocelectomy. Sperm retrieval was successful in 22 of 32 patients (68%) who had been operated because of varicocele and in 13 of 34 patients (38.2%) who had no varicocele (OR = 3.55) (CI: 1.15–11.27) (p = 0.025). Overall, sperm extraction was successful in 35 of 66 patients (53%). Repair of varicocele in non-obstructive azoospermic patients may return spermatogenesis to normal in spermatogenetic focuses. So, the presence of varicocele and its treatment might be considered as a prognostic factor for sperm retrieval in these patients.     

Efficacy and safety of varicocelectomies: A meta-analysis

This study reviewed the efficacy and safety of the three surgical approaches for varicocele (microsurgical, laparoscopic, and open varicocelectomy). A systematic review of the relevant randomized clinical trials was performed. Trials were identified from specialized trials register of the Cochrane UGDP Group, the Cochrane library, additional electronic searches (mainly MEDLINE, EMBSAE, SCI, CBM), and handsearching. Clinical trials comparing microsurgical, laparoscopic and open varicocelectomies were included. Statistical analysis was managed using Review Manager 5.3. Seven clinical trials of 1,781 patients were included. The meta-analysis indicated that compared with open varicocelectomy, microsurgery had a higher pregnancy rate (p=0.002), while there was nonsignificant difference between microsurgical and laparoscopic varicocelectomies or between laparoscopic and open varicocelectomies. Both microsurgical and laparoscopic varicocelectomies had a greater increase in postoperative sperm concentration than open varicocelectomy (p=0.008 and p=0.001, respectively). Microsurgical varicocelectomy also showed better improvement in postoperative sperm motility (p=0.02). Compared with the other two, microsurgical varicocelectomy had the longest operative time (p=0.01 and p=0.0004 respectively). A nonsignificant difference was found in the hospital stay between the three approaches, whereas microsurgical and laparoscopic varicocelectomies had a shorter time to return to work. Moreover, microsurgical varicocelectomy had a lower incidence of postoperative complications and recurrence compared with the others. Analysis of current evidence shows that microsurgical varicocelectomy has a longer operative time, lower incidence of postoperative complications, and recurrence than laparoscopic and open varicocelectomies, and shows a higher pregnancy rate, with a greater increase in postoperative sperm concentration, better improvement in postoperative sperm motility, and shorter time to return to work than open varicocelectomy.     

Frequency of varicocele in black adolescents

To determine the incidence of varicocele among blacks, 423 black adolescent males were examined. Fifty-eight (13.7%) had varicocele compared to a 14-15% incidence among white teenage males. The close to 10% of adolescents with a varicocele who develop subnormal fertility cannot be predicted, nor has it been shown that early varicocelectomy prevents the problem. There is a need for prospective evaluation of early varicocelectomy in adolescent males to determine if subnormal fertility can be avoided.     

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Varicocele is currently the most common irregularity identified in males that is associated with impaired spermatogenesis. It primarily presents in the form of decreased sperm count and motility, abnormal morphology, and significantly increased sperm DNA fragmentation. Several studies have shown that surgical repair improves semen parameters and increases the odds of spontaneous pregnancy. However the exact effect of surgical repair treatment remains controversial. Therefore, the aim of our study was to evaluate the effectiveness of microsurgical repair by comparing common semen parameters and sperm DNA fragmentation index (DFI). We evaluated infertile men (n?=?19) who underwent microsurgical subinguinal varicocelectomy for treatment of clinical varicocele before and 3 months after surgery. Normozoospermic men (n?=?19) were considered as the normal control group. Semen parameters improved significantly after surgery when compared with that before surgery, but still significant differences with the normal control group were observed. In comparison, sperm DNA integrity improved significantly after surgery (percentage DFI decreased from 28.4?±?15.6% before surgery to 22.4?±?12.9%, at 3 months post surgery) to similar levels as the normal control group. These results suggest that microsurgical repair may be considered as a treatment option in infertile men with palpable varicocele.     

精索静脉曲张对精子形态的影响

目的:探讨精索静脉曲张对精子形态的影响。方法:分析71例已有生育男性和417例男性不育患者精液样本,其中不育患者分为精索静脉曲张组Ⅰ°(130例)、Ⅱ°(64例)、Ⅲ°(88例)和无精索静脉曲张组(135例)4组。采用精子形态检测系统下人工修正方法进行精子形态分析。结果:精索静脉曲张Ⅱ°和Ⅲ°组正常形态精子百分率均显著低于生育组(P<0.05,P<0.001),但两组之间差异没有显著性(P>0.05)。精索静脉曲张Ⅰ°组正常形态精子百分率与生育组之间差异无显著性(P>0.05)。精索静脉曲张不育组正常形态精子百分率显著低于生育组和无精索静脉曲张组(P<0.005,P<0.05),梨形头精子、尾部/中部缺陷精子百分率显著高于生育组(P<0.05,P<0.005),大头精子、颈部/中段缺陷精子和尾部缺陷精子百分率显著高于无精索静脉曲张组(P<0.05),而其它畸形精子百分率显著低于无精索静脉曲张组(P<0.005)。结论:精索静脉曲张能够影响精子形态,Ⅱ°和Ⅲ°能导致正常形态精子百分率下降。     

ADENOVIRUS-MEDIATED p53 GENE TRANSFER TO RAT TESTIS IMPAIRS SPERMATOGENESIS

The aim of this study was to evaluate postoperative changes in sperm chromatin heterogeneity in varicocele patients. In 15 infertile patients with varicocele, sperm parameters including concentration, motility, and morphology were evaluated before and after surgical correction of varicocele. Sperm motion analysis using computer-assisted semen analyzer (CASA) was also performed. To analyze the sperm nuclear proteins, the acridine orange staining method was used. On semen analysis, sperm concentration and motility significantly increased after surgery (p = 0.002, p = 0.003, respectively), although sperm morphology was unaltered postoperatively. CASA parameters, including velocity, linearity, amplitude of lateral head displacement and beat cross frequency were unaltered postoperatively. On the other hand, acridine orange staining significantly increased postoperatively (p = 0.002). Varicocele influences the sperm chromatin condition, as well as sperm concentration and motility.