术前精液分析作为精索内静脉结扎术后生育功能恢复指标的探讨

目的:探讨精索静脉曲张的男性不育患者术前的精液分析结果,作为预测精索内静脉结扎术后精子活动及生育功能恢复指标的可行性。方法:诊断为男性不育的107例精索静脉曲张患者,以精液自动分析仪进行精液分析,据其活动精子总数(TMSC)≥20×106、(5~20)×106、<5×106分为A(n=32)、B(n=36)、C(n=39)3组。行左侧或双侧精索内静脉高位结扎术,术后3个月开始随访,进行精液分析,并了解其妻怀孕情况。结果:107例患者术后TMSC较术前有明显增加,但A、B组TMSC的绝对增加值明显高于C组(P<0.05);术前A、B两组68例中,术后有56例(82.4%)TMSC≥20×106,而C组39例中,术后仅8例(20.5%)TMSC≥20×106;患者妻子怀孕情况随访到98例,其中有36例自然妊娠,A、B两组怀孕率(56.3%和42.4%)与C组(12.1%)比较均有明显差异(P<0.05)。结论:精索内静脉高位结扎术对于术前TMSC≥5×106的精索静脉曲张所致男性不育患者是极为有效的治疗方法,而对于重度少弱精子症(TMSC<5×106)患者精子质量改善情况不佳。

The Value of Pre-operative Semen Analysis as a Restore Index of Fertilizing Capacity after Varicocelectomy

OBJECTIVE: To discuss the value of pre-operative semen analysis of patients with varicocele as a predictive restore index of sperm motility and fertilizing capacity after varicocelectomy. METHODS: Semen analysis was carried out with computer-aided sperm analyzer in 107 patients with varicocele and all patients were referred to the clinic with diagnosis of male infertility. Stratification of patients as group A (n = 32), B ( n = 36) and C (n = 39) was based on pre-operative total motile sperm count (TMSC). Follow-up included semen analysis and pregnancy data after three months following left or bilateral varicocelectomy. RESULTS: The average post-operative TMSC increased significantly when compared with the pre-operative. However, a mean absolute increase in group A and B was better than that in group C (P < 0.05). Of the 68 patients in groups A and B based on pre-operative TMSC, 56 patients' TMSC (82.4%) was > or =20 x 10(6) after varicocelectomy, and that of only 8 (20.5%) patients in group C was > or =20 x 10(6) following varicocelectomy. Of the 98 patients wives, 36 had natural conception. Pregnancy rates in groups A and B were higher than that in group C (P < 0.05). CONCLUSION: Varicocelectomy may be the most effective method to patients with varicocele with pre-operative TMSC > or = 5 x 10(6), but it may be not the best method for patients with severe oligoasthenospermia (pre-operative TMSC < 5 x 10(6)).