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。     

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。     

精索静脉高位结扎术对单侧精索静脉曲张不育患者精液质量、乳酸脱氢同工酶X含量及精子DNA完整性的影响

目的:探讨精索静脉高位结扎术对单侧精索静脉曲张(VC)不育患者精液质量、乳酸脱氢同工酶X(LDH-X)含量及精子DNA完整性影响。方法:VC(左Ⅲ°)伴不育患者42例,均行精索静脉高位结扎术。术前及术后3个月行计算机辅助精液分析、速率法检测精子及精浆LDH-X的含量、精子染色质扩散实验检测精子DNA的完整性。结果:精索静脉高位结扎术术前、术后精液量分别为(3.78±1.96)ml和(3.92±1.95)ml、精子浓度分别为(14.65±7.58)×106/ml和(40.50±9.05)×106/ml、前向运动精子百分率分别为(23.34±11.51)%和(45.75±10.32)%、精子活动率分别为(45.2±9.21)%和(67.45±9.45)%、精子存活率分别为(37.74±16.71)%和(70.05±17.18)%、精子DNA碎片指数(DFI)分别为(31.3±16.6)和(18.2±8.3)、精浆LDH-X含量分别为(926.3±58.3)U/L和(682.0±43.5)U/L、精子LDH-X含量分别为(6.90±3.8)mU/106和(21.1±9.2)mU/106、精浆/全精子LDH-X比值分别为1.69±0.26和0.41±0.17,差异均有统计学意义(P0.05)。结论:精索静脉高位结扎术能有效改善单侧VC不育患者的精液质量、乳酸脱氢同工酶X(LDH-X)含量及精子DNA完整性。     

胡桃夹综合征合并左精索静脉张的临床诊治

目的 探讨胡桃夹综合征(NCS)合并左精索静脉曲张的诊断和治疗方法.方法 回顾性分析23例NCS合并左精索静脉曲张患者的临床资料.全部病例均经多普勒超声或CT检查确诊.18例行经腹股沟左精索静脉高位结扎术,3例行腹腔镜下左精索静脉高位结扎术;2例行左肾静脉下移-下腔静脉端侧吻合术.结果 术后随访3～24(16.30±5.74)个月.全部病例阴囊坠胀感消失,静脉曲张团块消失.15例合并血尿或蛋白尿患者中,术后10例症状消失,5例仍有无症状性镜下血尿或蛋白尿.术后精液质量较术前改善:15例术前检查精液常规示精子密度为(28.36±3.12)×109/L,活动力(a+b)级为(36.50±4.25)％,术后6个月精子密度为(41.42±5.73)×109/L,活动力(a+b)级为(65.81±7.26)％.1例术后有轻度阴囊水肿,1例出现切口裂开,经清创缝合后愈合,无其他并发症发生.结论 多普勒超声对本病具有重要的诊断价值.NCS引起的左精索静脉曲张程度、症状都较重.血尿、蛋白尿较轻,可单纯行精索静脉高位结扎术;并发症明显者,左肾静脉下移-下腔静脉端侧吻合术是一个有效的治疗方法.     

显微外科与腹腔镜术治疗精索静脉曲张疗效比较

目的研究分析显微镜下精索静脉结扎术与腹腔镜辅助精索静脉结扎术治疗精索静脉曲张的疗效。方法选取2017年1月-2018年3月天津市武清区人民医院泌尿外科收治精索静脉曲张患者98例纳入研究,随机分为对照组和研究组各49例。对照组行腹腔镜精索静脉结扎术,研究组在显微镜下行精索静脉结扎术。分析比较两组手术指标、住院时间、精子质量及并发症情况。结果研究组手术、住院时间短于对照组,总出血量更低,差异有统计学意义(P0.05);术后,两组精子质量均有明显改善,且研究组精子密度、精子存活率以及A、B级活动力精子比例高于对照组,差异有统计学意义(P0.05)。结论显微镜辅助下精索静脉结扎术治疗精索静脉曲张疗效确切,相对腹腔镜辅助下精索静脉高位结扎术更有利于提高精子质量、降低术后并发症风险,值得临床应用推广。     

腹腔镜与开放手术治疗精索静脉曲张

目的：观察腹腔镜与开放手术治疗精索脉曲张的疗效。方法：采用腹腔镜精索内静脉高位结扎术40例 ，经腹股沟内环精索静脉高位结扎32例，术后随访3个月－3年。结果：所有患者术后精子计数、活动率、活动力较术前比较均有明显改善（P＜0．01），与常规手术组相比，腹腔镜组的精子计数、活动率、活动力改善更为明显（P＜0．01）。结论：腹腔镜精索内静脉高位结扎术治疗精索静脉曲张具有创伤小，疗效好，并发症少等优点，是治疗精索静脉曲张的理想方法。     

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。     

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。     

腹腔镜手术治疗精索静脉曲张102例疗效分析

目的:探讨经腹腔镜精索静脉高位结扎术治疗精索静脉曲张的意义。方法对经腹腔镜精索静脉高位结扎术治疗的102例精索静脉曲张患者进行分析,并与同期开放手术治疗的116例患者比较。结果:腹腔镜组平均住院时间3d±1.1d,对照组平均住院时间7d±1.5d,有显著差异(P<0.01);术后两组患者的症状、精液性质均较术前有显著改善(P<0.01),但术前、术后两组间同一参数相比无显著差异(P>0.05)。结论:经腹腔镜精索静脉高位结扎术具有创伤小、病人术后恢复快、疗效确切等优点,值得临床推广。     

三种术式治疗精索静脉曲张的临床疗效比较

目的 探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和传统开放手术(经腹股沟管精索静脉结扎术)治疗精索静脉曲张的临床疗效及差别.方法 将135例精索静脉曲张手术患者按照随机数字表法分为三组,腹腔镜下精索静脉高位结扎术组(A组,50例)、改良Palomo术组(B组,70例)和传统开放手术组(C组,15例),对三组患者的手术时间、住院时间、手术费用,术前、术后1、6、12个月的精液质量进行比较,并追踪18个月内患者精索静脉曲张复发、配偶临床妊娠结果 及睾丸萎缩的发生情况.结果 三组患者在单侧手术时间、住院时间方面比较差异无统计学意义(P>0.05);住院费用方面A组明显高于B、C组(P<0.05),而B、C组间比较差异无统计学意义(P>0.05);三组术后精液质量均较术前有显著提高(P<0.05),但组内术后1、6、12个月精液质量各参数比较差异无统计学意义(P>0.05).术后随访18个月,C组复发率13.3%(2/15),显著高于A组的0和B组的1.4%(1/70)(P<0.05),三组配偶临床妊娠率比较差异无统计学意义(P>0.05)[A组68.0%(34/50),B组68.6%(48/70),C组66.7%(10/15)].随访期间三组均无睾丸萎缩.结论 腹腔镜下精索静脉高位结扎术和改良Palomo术是治疗精索静脉曲张的安全、简单、有效的手术方式.对于单侧精索静脉曲张,改良Palomo术值得首先推荐;对于双侧和复发的精索静脉曲张,则可以优先考虑腹腔镜手术.

Abstract：

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.     

SOMATIC ANGIOTENSIN CONVERTING ENZYME IN VARICOCELE

The ACE is found as two isozymes in the body. A somatic isozyme found in blood and several other tissues, and a testis-specific isozyme found only in developing spermatids and mature sperm. In this study, we investigated the ACE activity in left spermatic vein blood samples of infertile patients with varicocele and its correlation to spermatologic parameters. The somatic ACE activities were determined in the peripheral and left spermatic vein blood samples from 31 infertile patients who underwent variococelectomy, and 11 fertile control subjects underwent left inguinal herniorraphy. The somatic ACE activity was measured by kinetic spectrophotometric assay. Semen analyses were performed according to WHO guidelines. The mean somatic ACE activities of peripheral and left spermatic veins of the varicocele group were 60.3 ± 23.0 and 60.2 ± 23.2 U/L, respectively. In control group, peripheral and left spermatic vein ACE activities were found as 56.8 ± 17.1 and 56.5 ± 15.5 U/L, respectively. There was no significant difference between the ACE activity in peripheral and left spermatic vein blood sample from the varicocele and control group. There was no statistically significant correlation between the spermatologic parameters and ACE activities in the spermatic and peripheral vein in both of varicocele and control groups. As a result, it may be suggested that the somatic ACE has no causative role in pathophysiology of varicocele and varicocele related infertility.     

Ⅲ度精索静脉曲张患者术后性激素的变化

目的分析Ⅲ度精索静脉曲张患者手术前后性激素的改变,探讨手术治疗精索静脉曲张的疗效。方法 2009年1月至2011年12月河源市人民医院收治的108例Ⅲ度精索静脉曲张患者,患者平均年龄28.3岁(18～36岁),术前抽血测血清睾酮(Testo)、促卵泡成熟激素(hFSH)、促黄体生成激素(hLH)、催乳素(Prol)水平,所有患者均行精索静脉高位结扎术,术后半年抽血复查外周血清性激素;统计分析手术前后患者性激素水平的变化。正常组为具有正常生育能力的健康男性35例,平均年龄26.8岁(19～37岁),同样抽血测血清性激素水平。结果患者术前血清Testo值低于正常组,而hLH、hFSH、Prol值较正常组明显升高(P<0.05),术后患者血清T、DHT值较术前升高,而hLH、hFSH、Prol值较术前降低,术前术后患者性激素比较有统计学差异(P<0.05)。结论Ⅲ度精索静脉曲张能引起性激素的改变,精索静脉高位结扎术后性激素水平明显改善。     

单孔腹腔镜精索静脉高位结扎术153例临床报告

目的总结单孔三通道腹腔镜手术治疗原发性精索静脉曲张的手术经验。方法系统回顾分析我院2006年至2009年采用单孔腹腔镜精索静脉高位结扎术治疗的153例患者病例资料。结果 153例手术中,除1例复发外,均无远期并发症发生,随访6～12月术后恢复良好。结论单孔三通道腹腔镜精索静脉高位结扎术是一种较理想的手术方式,值得临床推广应用。     

精索静脉曲张外环下结扎加提睾肌折叠术临床观察

目的探讨外环下切口在精索静脉曲张手术应用的效果。方法对56例接受外环下切口入路行精索静脉结扎＋提睾肌折叠术的患者术后3个月、6个月及12个月精液质量情况及术后并发症发生率进行评估,并与接受精索静脉高位结扎术的患者进行对比。结果外环下切口组对提高精液质量,减少术后并发症有明显疗效。结论外环下切口是治疗精索静脉曲张一种较简单、可靠、可行的方法。     

精索静脉曲张不育患者精索静脉血精浆中锌和镉的测定及意义

用原子吸收光谱法 ( AAS)测定 1 8例精索静脉曲张 ( VC)不育患者和 1 4例正常生育的斜疝和或鞘膜积液患者外周静脉血、精索静脉血、精浆中的 Zn和 Cd的含量。结果表明 :精索静脉曲张不育患者精索静脉血和精浆中 Cd含量较对照组明显增高 ( P<0 .0 1 )、而精浆中的 Zn含量较对照组明显减低 ( P<0 .0 1 )。此外 ,其精索静脉血和精桨中 Cd/Zn比值与对照组也有显著性差异 ( P<0 .0 1 )。提示 Cd的增高可能是导致精索静脉曲张不育的原因之一。     

Clinical experience with gossypol in non-Chinese men: a follow-up

Gossypol monoacetic acid was administered to 12 Brazilian volunteers. The initial dose was 20 mg daily for 4 months. The dose was then reduced to 60 mg weekly (20 mg three times weekly). A significant reduction in sperm motility was detected in all subjects. An increase in the number of immature cells in the ejaculate was also detected in all subjects. Severe oligospermia or azoospermia developed in all subjects at the end of the loading phase. Two years following discontinuation, 3 men were still azoospermic. Only 1 man who was azoospermic 2 years after discontinuation had a late (3 years) recovery. Two of the 3 men who were subjected to high spermatic vein ligation because of varicocele remained azoospermic 2 years after the operation. The third patient, who did not have the operation, also remained azoospermic. Of the 9 patients who recovered, 3 had fathered children during the last 2 years.     

禁欲时间对人精子顶体酶活性精子密度和精子数的影响

目的:了解禁欲时间对人精子顶体酶活性、精子密度和精子数的影响。方法:分光光度比色法测定精子顶体酶活性。结果:禁欲1～5d时,顶体酶活性是稳定的,而禁欲10d时顶体酶活性明显下降,与禁欲1d时顶体酶活性比较差异有显著性(P<0.05)。精子密度和精子数随禁欲时间增加而增加,禁欲10d精子密度约为禁欲1d精子密度2倍,禁欲10d精子总数约为禁欲1d的4倍。结论:禁欲时间影响顶体酶活性、精子密度和精子数。