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。     

精索静脉曲张超声分型与手术前后精液质量变化对比研究

目的:探讨精索静脉曲张(VC)的超声分型对手术前后精液质量改善的影响。方法:经彩色多普勒超声(CDU)诊断为VC患者共129例,以蔓状静脉丛(PPV)反流程度、PPV最大内径、PPV最大内径和反流程度3种不同分级指标分为VCⅠ级、VCⅡ级、VCⅢ级,所有患者均行精索静脉高位结扎,术前及术后均行精液常规检查。结果:以PPV的最大内径为分级标准,术前术后精液质量VCⅠ级、VCⅡ级无明显改变(P>0.05),VCⅢ级较术前有显著改变(P<0.05),以PPV的反流程度或以PPV的最大内径和反流程度为分级标准,术前术后精液质量VCⅠ级无显著差异(P>0.05),VCⅡ级有显著差异(P<0.05),VCⅢ级有极显著差异(P<0.01)。精子的畸形率各级组间均无显著差异(P>0.05)。结论:不同的分级标准对手术前后精液质量改善的评价有一定的影响,以PPV的反流程度或以PPV的最大内径和反流程度为分级标准更为合理、可靠。不同曲张等级VC手术效果不同,CDU诊断为VCⅠ级患者是否必要行手术治疗有待进一步探讨。     

精索静脉曲张手术后治疗效果的观察

分析我院自 1990年以来 93例有较完整随访资料的精索静脉曲张不育病人手术后治疗情况的资料 ,认为术后的药物治疗也是不可忽视的。1　资料与方法精索静脉曲张病人 93例 ,年龄 19～ 36岁 ,均因不育来就诊 ,不育时间 1～ 10年。精索静脉曲张双侧 4 5例 ,左侧 32例 ,右侧 16例 ;其中 Ⅰ 度 35侧 ,Ⅱ度 80侧 ,Ⅲ度 2 3侧。均采用精索静脉高位结扎术。术后治疗组 (ｎ =62 ) :术后第 1个月ｈＣＧ 10 0 0Ｕ肌注 ,隔日 1次 ,第 2个月后改为ｈＣＧ 10 0 0Ｕ肌注 ,每周 2次 ,共 3个月 ;口服维生素Ｅ 10 0ｍｇ和以益气活血、补肾益精为主的中药。未治疗…     

精索静脉曲张与男性不育

精索静脉曲张(VC)是导致男性不育的最常见原因之一,手术是治疗VC的主要方法。近来,关于VC导致不育的病理机制研究较多,尤其是细胞分子机制的研究进展较快,主要包括生精细胞凋亡异常和氧化应激。同时,对于VC手术指征和各种术式优劣性的认识也渐趋统一。本文介绍VC导致不育的细胞分子机制及临床治疗决策的研究进展。     

精索静脉曲张患者精液质量及其不育患者手术前后精液变化的观察

目的观察精索静脉曲张（VC）患者的精液质量和精子形态学改变，以及VC不育患者手术前后精液的变化。方法121例VC患者精液按WHO标准常规分析并对精子形态学进行评价，23例健康男性精液检查结果作为对照。并对21例VC不育患者术前及术后的精液进行检测分析。结果121例VC患者的精子密度、（A＋B）级活动力精子（％）、活率、有效精子数、活动精子数、活力指数以及正常形态精子比例较对照组明显降低（P〈0．01）；畸形精子中小头、锥形头和无定形头精子数较对照组增多（P〈0．01）。21例VC不育患者手术后精子质量和精子形态学较术前明显改善。结论VC可以引起精液质量下降导致不育，精子形态学分析是判定VC患者精子受损的一个敏感指标，手术能有效地改善精液质量。     

精索静脉曲张不育患者精子质量及其超微结构的研究

目的:研究精索静脉曲张不育患者精液质量及精子超微结构的变化。方法:不育伴精索静脉曲张患者118例作为实验组(VC组),正常自愿捐精者76例作为对照组,对其精液常规、精浆生化及外周血内分泌水平进行检测,并应用扫描和透射电镜技术对精子的超微结构进行观察。结果:VC组精液常规检查中,精子浓度、前向运动能力、存活率显著低于正常组(P<0.05),精液量、非前向运动能力无差异(P>0.05),精浆生化各项指标中,果糖浓度无显著差异,中性α-葡糖苷酶、锌离子浓度均显著低于正常组(P<0.05),外周血FSH、LH、T、E2水平均无统计学差异(P>0.05)。扫描电镜检查示正常形态精子比率低于对照组[(56.76±15.32)%vs(12.34±6.58)%,P<0.05],精子异常主要发生在头颈部,透射电镜检查示精子畸变以尖头为主,且伴有分化异常的复杂畸形。结论:VC可导致少-弱-畸精子症,进而引起不育,其原因可能是由于精浆微环境及超微结构的改变。     

精索静脉曲张手术后患者的管理策略

手术治疗精索静脉曲张在改善精液质量、提高配偶自然怀孕率和缓解局部疼痛症状中的作用已为多数医生所认同.随着手术方式的改进,越来越多的精索静脉曲张患者接受手术治疗,然而,临床对手术后患者的管理还重视不够.本文系统介绍了对精索静脉曲张手术后患者的疗效判断和后续治疗选择,包括观察随诊、非手术治疗方法和再手术.     

精索静脉曲张不育症与阴囊温度变化关系的研究

精索静脉曲张不育症与阴囊温度变化关系的研究金讯波，刘霞，曹铭溪，杨忠广原发性精索静脉曲张与男性不育之间的关系至今尚未完全明了。自Ｇｒｅｍ１９２１年首先提出精索静脉曲张病人的睾丸温度升高可能是这部分病人不育症的原因以后，对于本病睾丸温度的高低能否导致不...     

显微外科精索静脉曲张切除术治疗男性不育

精索静脉曲张(VAC)是导致男性不育的常见原因。手术是治疗VAC的主要方法。传统手术方法包括Palo-mo手术、经腹股沟精索内静脉高位结扎术及腹腔镜手术术后睾丸鞘膜积液、睾丸动脉损伤等并发症的发生率及VAC复发率较高。近年来国际上兴起的显微外科精索静脉曲张切除术(MV)可有效的保护精索淋巴管及睾丸动脉,彻底结扎除输精管静脉外的所有精索静脉,使并发症及复发率大为降低。MV可显著改善VAC不育患者的精液质量,提高妊娠率;对严重少弱精子症或非梗阻性无精子症的患者的精液质量也有改善作用,目前已成为治疗VAC的"金标准"。     

精索静脉曲张所致不育的免疫学研究

目的研究精索静脉曲张(VC)所致不育与抗精子抗体(AsAb)的关系。方法240例男性不育患者分为VC组和对照组,行精液常规和AsAb检测。结果VC组AsAb阳性率为37.9%,对照组阳性率为25%,两组间有显著性差异(P<0.05);VC组中AsAb阳性率与临床分级密切相关(P<0.005),与精子密度亦明显相关(P<0.01)。结论免疫因素可能是导致VC不育的原因之一。     

Is unilateral varicocelectomy as effective as bilateral varicocelectomy in management of subfertile patients with bilateral varicocele

Objectives

To compare the results of unilateral and bilateral subinguinal varicocelectomy for patients with primary infertility, including sperm parameters and pregnancy rate.

腹腔镜精索静脉高位结扎术治疗精索静脉曲张26例报告

目的：探讨腹腔镜精索静脉高位结扎治疗精索静脉曲张的临床价值,总结保留睾丸动脉的单纯精索内静脉高位结扎术及睾丸动静脉集柬高位结扎术的优缺点。方法：回顾分析腹腔镜精索静脉高位结扎术治疗精索静脉曲张26例患者的临床资料,其中14例行保留睾丸动脉的单纯精索内静脉高位结扎术,12例行睾丸动静脉集柬高位结扎术。结果：26例手术均获成功。6例术前诊断为左侧精索静脉曲张的病例术中确诊为双侧精索静脉曲张。睾丸动静脉集柬高位结扎术中1例并发附睾炎。以不育就诊的14例中,保留睾丸动脉的单纯精索内静脉结扎的8例中4例生育,而睾丸动静脉集柬高位结扎的6例中只有1例生育,全部病例未见复发。结论：腹腔镜下精索内静脉高位结扎术具有损伤小,视野清楚,操作简单,并发症少,术后恢复快等优点,尤其适合双侧精索静脉曲张者,可同时探查和治疗双侧精索静脉曲张。保留睾丸动脉的单纯精索内静脉高位结扎术能提高不育症的疗效,减少鞘膜积液的发生率。     

Sperm dysfunction in subfertile patients with varicocele and marginal semen analysis

A comparative analysis of potentially functional spermatozoa per ejaculate, progressive motility, hypo-osmotic swelling test, acrosome integrity and sperm viability (24 and 48 h) was carried out in a group of 40 subfertile patients with varicocele and marginal semen analysis and 40 fertile subjects, in order to identify subclinical abnormalities that may explain subfertility. Patients with varicocele had lower numbers of potentially functional spermatozoa per ejaculate, progressive motility, acrosome and membrane integrity and sperm viability. These abnormalities were not related to the grade of varicocele, testicular volume or serum FSH concentration. A positive correlation between the hypo-osmotic swelling test and progressive motility (r = 0.71) and between potentially functional spermatozoa and the hypo-osmotic swelling test (r = 0.69) was found in patients with varicocele. These data suggest that some of the deleterious effects produced by the varicocele might be related to sperm migration and viability in the female genital tract and others to sperm-zona interaction and/or sperm-egg fusion.     

精索静脉曲张合并前列腺炎患者血清性激素水平变化

目的 了解原发性精索静脉曲张合并慢性前列腺炎(CP)者性激素睾酮(Testo)、促黄体生成素(LH)、泌乳素(PRL)水平的变化,探讨性激素在精索静脉曲张合并慢性前列腺炎病理生理中的作用.方法 采用化学发光免疫分析法(CIA)检测148例原发性精索静脉曲张合并慢性前列腺炎者的血清性激素水平,其中左侧精索静脉曲张合并前列...     

Effects of grade 1 varicocele detected in the pediatric age-group on testicular development

Purpose

A number of reports have indicated the effectiveness of varicocelectomy on large varicoceles in adolescents. We carried out a 5-year follow-up study to examine the effect of grade 1 varicocele on testicular development.

Methods

Of 31 boys with left grade 1 varicocele (mean age, 12.6 years), 10 underwent microsurgical varicocelectomy and 21 were conservatively observed and evaluated for testicular volume and varicocele grade. The control group consisted of 20 healthy age-matched boys without a varicocele. The mean relative left testicular volume was compared with the right testis and the absolute bilateral testicular volumes among the boys in all groups.

Results

Of 21 boys who were observed, 13 (62%) continued to have grade 1 varicocele, 4 (19%) developed grade 2 varicocele, and the other 4 boys (19%) showed spontaneous resolution. Twelve testes (57%) developed in parallel with the right testis, and 1 boy (5%) who experienced spontaneous resolution of the varicocele had catch-up testicular growth, whereas 8 boys (38%) had left testicular growth delay with or without an increasing grade of varicocele. Varicocelectomy, but not observation, improved the previously noted testicular growth delay. Furthermore, right testicular growth delay was also noted during observation.

Conclusions

More than half of the total number of boys with grade 1 varicocele showed normal development, whereas many boys presented with growth delay in both testes. Thus, we still need to define reliable predictors that will permit selection of the best candidates for varicocelectomy.     

精索静脉曲张患者精子运动速度和ATP含量的比较研究

为了探究精索静脉曲张患者不育的原因，采用多次曝光法和生物发光法测定精索静脉曲张患者精子运动速度和三磷酸腺苷（ＡＴＰ）含量，并与有生育能力的健康男性精子进行比较，结果显示静索静脉曲张患者精子运动速度和ＡＴＰ含量显著低于正常对照组（Ｐ〈０．００１，Ｐ〈０．０１）。８例精索静脉曲张患者在作精索内静脉高位结扎术后６个月，其精子运动速度和ＡＴＰ含量与正常对照组无显著性差异（均Ｐ〉０．０５）。精子的ＡＴＰ含量     

Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair

Context

Varicocele is a common condition, found in many men who present for infertility evaluation.

Objective

To assess the effect of varicocelectomy on male infertility.

Evidence acquisition

A literature search was performed using Embase and Medline. Literature reviewed included meta-analyses and randomized and nonrandomized prospective (controlled and noncontrolled) studies. In addition, a new meta-analysis was performed.

Evidence synthesis

Four randomized controlled trials reporting on pregnancy outcome after repair of clinical varicoceles in oligozoospermic men were identified. Using the random effect model, the combined odds ratio was 2.23 (95% confidence interval [CI], 0.86-5.78; p = 0.091), indicating that varicocelectomy is moderately superior to observation, but the effect is not statistically significant. We identified 22, 17, and 5 prospective studies reporting on sperm concentration, total motility, and progressive motility, respectively, before and after repair of clinical varicocele. The random effect model combined improvement in sperm concentration was 12.32 million sperm per milliliter (95% CI, 9.45-15.19; p < 0.0001). The random effect model combined improvement in sperm total and progressive motility were 10.86% (95% CI, 7.07-14.65; p < 0.0001) and 9.69% (95% CI, 4.86-14.52; p = 0.003), respectively. These results indicate that varicocelectomy is associated with a significant increase in sperm concentration as well as total and progressive motility. Prospective studies also show that varicocelectomy reduces seminal oxidative stress and sperm DNA damage as well as improving sperm ultramorphology. Studies indicate that a microsurgical approach to a varicocele repair results in less recurrence and fewer complications than other techniques.

Conclusions

Although there is no conclusive evidence that a varicocele repair improves spontaneous pregnancy rates, varicocelectomy improves sperm parameters (count and total and progressive motility), reduces sperm DNA damage and seminal oxidative stress, and improves sperm ultramorphology. The various methods of repair are all viable options, but microsurgical repair seems to be associated with better outcomes.     

The relationship between varicocele and semen nitric oxide concentrations

We investigated the relationship between seminal plasma nitric oxide (NO) concentrations and conventional semen parameters in patients with varicocele. Semen samples were obtained from infertile patients with varicocele (n=55) and from normal controls (n=48). The mean NO concentration in the seminal plasma of patients with varicocele was significantly higher than that of the controls (P < 0.01). A significant negative correlation was noted between NO and sperm motility (r=−0.29, P=0.003), NO and sperm concentration (r=−0.26, P=0.008) and NO and normal morphology (normal %) (r=−0.25, P=0.01). It was concluded that increased NO production may influence sperm production, motility and morphology in patients with varicocele. Received: 21 February 2000 / Accepted: 20 June 2000