精索静脉曲张患者术前、后精子顶体酶活性研究

目的 探讨精索静脉曲张患者在精索静脉高位结扎术前、后精子顶体酶活性(SAA)的变化。方法 用改良的Kennedy法测定术前和术后6～8个月精子顶体酶活性。结果 精索静脉高位结扎术后患者的精子顶体酶活性较术前明显增高(P<0.01)。结论 精索静脉高位结扎术后精索静脉曲张患者精液质量如精子顶体酶活性得到明显的提高。     

腹腔镜下精索静脉高位结扎术对精液质量影响的临床观察

目的 研究腹腔镜下精索静脉高位结扎术对精液质量的影响.方法 收集北京航天总医院泌尿外科2013年10月-2015年6月接受腹腔镜下精索静脉高位结扎术的左侧精索静脉曲张患者50例,根据曲张静脉直径分为Ⅱ级12例(A组),Ⅲ级38例(B组),术前及术后1、3、6个月行精液常规检查,比较两组精液量、精子密度、精子总数、a+b+c级精子活动率、a+b级精子活动率、a级精子活动率、精子存活率及正常形态精子率.结果 50例患者术后均随访6个月以上,术后1、3、6个月精液量与术前比较差异无统计学意义(P＞0.05);术后1个月精子密度、精子总数、精子活动率、精子存活率及正常形态精子率较术前有所提高,但差异无统计学意义(P＞0.05);而术后3个月较术前及术后1个月明显改善,差异有统计学意义(P＜0.05);术后6个月与术后3个月比较差异无统计学意义(P＞0.05).两组组间比较术前精液常规比较差异无统计学意义(p＞0.05);术后6个月精子存活率比较差异有统计学意义(P＜0.05).组内比较A组术后1个月精子密度较术前明显改善,差异有统计学意义(P＜0.05);B组术后1个月精子密度、精子活动率及正常形态精子率较术前明显改善,差异有统计学意义(P＜0.05).结论 腹腔镜下精索静脉高位结扎术可显著改善精索静脉曲张患者精液质量,对于精液质量下降的精索静脉曲张患者建议早期腹腔镜手术治疗,术后3个月精液参数明显改善并维持稳定.     

腹腔镜精索血管集束状结扎与改良Palomo术治疗精索静脉曲张的疗效比较

目的探讨原发性精索静脉曲张不育患者作腹腔镜精索血管集束状结扎术与改良Palo—mo术的治疗效果。方法选择原发性精索静脉曲张不育患者80例，均有不同程度的生精功能障碍。病例随机分为两组，第一组42例，行腹腔镜下精索血管集束结扎术；第二组38例，行开放式腹膜后精索静脉高位结扎术。两组术前及术后3个月检查精液分析。将42例与38例开放式腹膜后精索静脉高位结扎术的临床资料进行对比研究。结果两组病例手术时间与术中出血量有明显差异（P〈0．05）；术后经12个月随访，两组间术后复发率有明显差异（P〈0．05）。两组精液质量较术前均有改善，而两组间精液精子数量、活动力、畸形率比较无显著性差异（P〉0．05）。结论腹腔镜精索血管集束状结扎术与开放式腹膜后精索静脉高位结扎术均可提高精液质量，但前者具有手术时间短、术中出血少、安全且治愈率高的优点。     

双侧精索静脉曲张:双侧手术和单侧手术对精液质量影响的比较

目的 探讨患双侧精索静脉曲张的患者应选择双侧精索静脉结扎术还是单侧精索静脉结扎术. 方法 我们将68例有精液异常的并且患有左侧Ⅱ、Ⅲ级伴右侧Ⅰ级精索静脉曲张的患者随机分成两组,然后对手术前2周和手术后半年的3项精液参数:精子密度、精子活力和正常形态精子数进行统计分析. 结果 两组患者术后的精液参数均得到改善,其中在精子密度和精子活力(主要指a级)两项参数上的差异有显著统计学意义,而在正常形态精子数上的差异无统计学意义. 结论 患有左侧Ⅱ、Ⅲ级伴右侧Ⅰ级精索静脉曲张的患者,实行双侧精索静脉结扎术比单侧精索静脉结扎术的效果改善明显.     

三种不同术式治疗精索静脉曲张：前瞻性随机对照研究

目的探讨改良Palomo腹膜后精索内静脉高位结扎术、腹腔镜腹膜内精索内静脉高位结扎术以及显微镜辅助下经外环下精索静脉结扎术三种不同手术方式治疗精索静脉曲张的临床疗效。方法选择2017年6月至2019年6月在我院手术治疗的150例精索静脉曲张患者,按照随机数字表法分为三组,每组50例,分别行改良Palomo腹膜后精索内静脉高位结扎术(传统组)、腹腔镜腹膜内精索内静脉高位结扎术(腹腔镜组)及显微镜辅助下经外环下精索静脉结扎术(显微镜组)。比较三组患者围手术期指标、术后1年精液质量改善情况、自然致孕率、并发症发生率以及复发率。结果所有患者均顺利完成手术。三组比较,显微镜组手术时间最长、排气时间最短,差异有统计学意义(P0.05)。而术中出血量和住院时间比较,三组间差异均无统计学意义(P0.05)。显微镜组术后并发症发生率及复发率均明显低于腹腔镜组和传统组,差异有统计学意义(P0.05)。所有患者术后随访1年。术后1年三组患者精子密度、A+B级活动力精子、精子存活率均较术前明显改善,差异有统计学意义(P0.05),并且显微镜组上述指标及自然致孕率明显优于传统组和腹腔镜组,差异均有统计学意义(P0.05)。结论显微镜辅助下经外环下精索静脉结扎术治疗精索静脉曲张可有效改善精液质量,术后自然致孕率高,并发症少,复发率低,具备开展条件的医疗单位可优先选择此方法。     

Percoll优选对形态正常精子百分率和顶体酶活性的影响

目的 :了解形态正常精子百分率和顶体酶活性在Percoll优选前后的变化。　方法 :30例不育男性精液标本 ,应用计算机精液分析仪进行精子形态分析 ,分光光度比色法检测顶体酶活性。　结果 :Percoll优选后形态正常精子百分率和精子顶体酶活性均明显高于Percoll优选前 (P均 <0 .0 0 1)。　结论 :Percoll法优选精子后形态正常精子百分率和顶体酶活性增加。     

优选前后精子顶体酶活性与IVF受精率相关性的研究

目的探讨优选处理前和处理后精子顶体酶活性的变化,及与体外受精(IVF)受精率的相关性。方法采用分光光度比色法,对接受IVF治疗的53例不育夫妇男方精液,分别测定优选处理前和处理后精子顶体酶活性,分析其与IVF受精率的相关性。结果优选处理后精子顶体酶活性与优选前比较有显著性差异(P<0.05);达到常规IVF标准并选择常规IVF治疗者,优选后的精子顶体酶活性与IVF受精率有相关性,精子顶体酶活性降低与IVF受精率降低有关。结论精子顶体酶活性与IVF受精率有相关性,并且通过精子顶体酶活性可以预测IVF受精率。     

显微镜下三种术式治疗精索静脉曲张疗效比较

目的:探讨显微镜下精索静脉结扎不同术式治疗精索静脉曲张的效果。方法:选取147例精索静脉曲张患者作为研究对象,依据采取的术式不同将其分为Ⅰ、Ⅱ、Ⅲ组各49例。Ⅰ组行经腹股沟精索静脉高位结扎术,Ⅱ组行经腹膜后精索静脉高位结扎术,Ⅲ组行精索静脉低位结扎术。对比3组的手术相关指标以及住院时间、精子质量以及并发症和复发情况。结果:Ⅰ组手术时间(55.28±15.36)min、Ⅱ组手术时间(56.04±16.730)min,均明显短于Ⅲ组(75.29±16.97)min;3组出血量及总住院时间差异无统计学意义(P0.05)。术后1年,3组精子密度、存活率及(A+B)级活动力精子比例较术前均显著提高,Ⅲ组精子密度[(185.36±49.37)×10~6/m L]较Ⅰ组[(149.65±38.22)×10~6/mL]和Ⅱ组[(148.77±39.62)×10~6/m L]显著升高(P0.05),Ⅲ组存活率[(99.55±22.16)%]较Ⅰ组[(73.45±17.21)%]和Ⅱ组[(74.08±18.06)%]显著升高;Ⅲ组(A+B)级活动力精子比例[(91.79±25.68)%]较Ⅰ组[(70.25±15.16)%]和Ⅱ组[(72.83±17.58)%]显著升高。Ⅲ组术后并发症发生率为5.56%,较Ⅰ组(23.61%)和Ⅱ组(20.83%)显著降低。3组复发情况差异无统计学意义(P0.05)。结论:显微镜下精索静脉结扎术治疗精索静脉曲张效果确切,精索静脉低位结扎术相对于经腹膜后或腹股沟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。     

腹腔镜精索静脉高位结扎术对精子质量及妊娠结局的影响

目的探讨腹腔镜保留动脉精索静脉高位结扎术对精子质量的影响。方法回顾分析33例我院2011年4月至2012年7月因不育就诊的精索静脉曲张患者,并行腹腔镜保留动脉精索静脉高位结扎手术,分别比较手术前后精液各参数变化,包括精液容积(mL)、精子浓度(×10~6/mL)、前向运动精子百分率(%)、前向运动精子总数(×10~6)等。结果腹腔镜保留动脉精索静脉高位结扎术后精子浓度(29.20±26.69)×10~6/rnL、前向运动精子百分率(31.33±16.21%),前向运动精子总数(34.81±36.19)×10~6与术前精子浓度(13.72±17.43)×10~6/mL、前向运动精子百分率(17.06±10.25)%,前向运动精子总数(8.06±8.42)×106比较,均有统计学意义(P0.05),其中15例手术后1年中女方怀孕,妊娠率为48.48%。术后精液容积(3.80±1.24)mL与术前相比(3.66±1.60)mL差异无统计学意义(P0.05)。结论腹腔镜保留动脉精索静脉高位结扎术可以明显改善不育伴精索静脉曲张患者的精子浓度、前向运动精子百分率,前向运动精子总数,而精液容积无改善。48.48%不育症患者手术后1年内可使女性正常怀孕。     

彩色多普勒超声在精索静脉曲张高位结扎术后随访中的价值

目的：探讨彩色多普勒超声在精索静脉曲张高位结扎术后随访中的价值。方法选择63例经临床确诊为左精索静脉曲张并行精索静脉曲张高位结扎术的患者,分别用彩色多普勒超声测量术前、术后6个月睾丸包膜动脉血流参数,测值包括：收缩期峰值速度（ PSV）、舒张末期血流速度（ EDV）、阻力指数（ RI）;同时,对比手术前后精液质量,包括：精子总数、活率、精子密度。结果与术前相比,术后患者精液质量明显提高（ P ＜0．05）;术后6个月左侧睾丸包膜动脉PSV、RI下降（ P ＜0．05）,EDV差别无统计学意义（ P ＞0．05）;术后右侧睾丸包膜动脉PSV、EDV、RI差异无统计学意义（ P ＞0．05）。相关分析显示,左侧睾丸包膜动脉PSV、RI与精子密度相关（ P ＜0．05）。结论精索静脉曲张高位结扎可有效改善睾丸血供及精液质量;彩色超声多普勒睾丸包膜动脉阻力指数检测可作为精索静脉曲张术后随访的重要指标。     

不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的疗效分析

目的探讨不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的临床疗效。方法回顾性分析郑州大学第一附属医院在2015年7月至2018年9月期间诊治的胡桃夹综合征所致左侧精索静脉中重度曲张患者的临床资料。56例患者共分为3组,24例患者行显微镜下左侧精索静脉低位结扎术+精索外静脉剥离切除术为低位结扎组;19例患者行开放性左侧精索静脉高位结扎术为高位结扎组;13例患者左侧精索静脉中重度曲张并有血尿和/或蛋白尿,行腹腔镜下左肾静脉外支架固定术+生殖静脉结扎术,为血蛋白尿组。术后随访6~30个月,平均(11.5±6.5)月,患者于术前及术后6个月复查阴囊彩超及精液分析,对比精索静脉直径和精液恢复情况。结果①3组患者组内比较:精索静脉直径术后显著小于术前,精子浓度、精子活率术后显著高于术前,差异均有统计学意义(P均<0.01);组间比较:精子浓度3组间术前术后差异均无显著性统计学意义(P均>0.05);而精索静脉直径低位结扎组优于其他2组,精子活率的提高低位结扎组优于其他2组,差异均有统计学意义(P均<0.05)。②血蛋白尿组患者术后随访血尿、蛋白尿症状消失,左肾静脉受压状况明显改善,低位结扎组、高位结扎组左肾静脉受压状况无明显改善。结论显微镜下左侧精索静脉低位结扎术是治疗胡桃夹综合征所致左侧精索静脉中重度曲张的一种姑息、有效的手术方式。     

双侧精索内动静脉结扎术后睾丸体积、精液质量变化的初步观察

目的初步评价双侧精索内动静脉结扎术后睾丸体积及精液质量的变化。方法对34例双侧精索静脉曲张患者中的16例行双侧精索内动静脉结扎术,于术前及术后随访时彩超测量睾丸体积,并行精液常规检查。结果睾丸体积无明显变化(P>0.05);精液量、精子数、精子活率明显提高(P<0.01),精子畸形率明显下降(P<0.01)。结论双侧精索内动静脉结扎术后睾丸无萎缩,精液质量明显改善。     

精索静脉高位结扎术后联合复方玄驹胶囊治疗弱精子症

目的:观察腹腔镜精索静脉高位结扎术联合复方玄驹胶囊治疗精索静脉曲张弱精子症的疗效。方法:选择精索静脉曲张合并弱精子症患者75例,按住院号单双随机分成治疗组(n=39)和对照组(n=36),均行腹腔镜精索静脉曲张高位结扎术,术后治疗组联合复方玄驹胶囊口服,对照组静止观察。12周后对两组治疗前后精液量、精子密度、精子总活力、精子存活率、精子形态等精液参数进行分析,并对促卵泡激素(FSH)、促黄体素生成激素(LH)、睾酮(T)、血清抑制素B等激素改变进行比较。结果:两组治疗12周后,(1)治疗组精子参数显示:精液量增加(1.2±0.41)mL、精子密度增加(2.7±1.85)×106/mL、总活力增加(24.5±6.10)%、精子存活率提升(25.1±7.32)%、正常精子形态提升(2.0±1.29)%,改善均显著优于对照组(P0.01)。(2)治疗组相关激素水平显示:T提高(9.1±6.43) nmol/L、FSH下降(5.2±1.54)IU/L、LH下降(3.7±0.95)IU/L、血清抑制素B提高(26.1±15.03)pg/mL,改善均显著优于对照组(P0.01)。结论:精索静脉高位结扎术后联合复方玄驹胶囊治疗弱精子症,能较好提高精子质量,改善性激素水平,提高治疗有效率。     

Sperm ultramorphology as a pathophysiological indicator of spermatogenesis in males suffering from varicocele

Varicocele of spermatic veins is considered to be one of the major causes of male infertility associated with reduction of sperm quality. The pathophysiology of this condition is not yet completely understood. The aim of this study was to shed light on the pathophysiology of varicocele by identifying semen parameters, especially sperm ultramorphology, which improve following high ligation of the spermatic vein. Seventy-five males with diagnosed varicocele were included in this study. Semen parameters were assessed prospectively using light microscopy, semen biochemistry and sperm quantitative ultramorphological analysis, before high ligation and 3-9 months after high ligation. The control group consisted of twenty-five untreated varicocele patients who underwent two semen examinations within 3-9 months. No statistical difference in any of the examined variables was found between the two examinations in the control group. The treated patients exhibited a significant improvement in sperm density, progressive motility, percentage of normally formed spermatozoa, agenesis of sperm acrosome, chromatin condensation and incidence of amorphous heads compared with the pretreatment condition (P < or = 0.01). In contradiction, no significant improvement was observed following treatment in any of the sperm tail subcellular organelles. It is concluded that varicocele may cause deleterious alterations in early spermatid head differentiation during spermiogenesis and that varicocele patients with a high incidence of sperm acrosome and nucleus malformations are appropriate candidates for varicocele correction.     

Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men

To know the parameter related to improvement of each semen characteristic (sperm density and percentage of progressive motile sperm) after high ligation of the left internal spermatic vein, 119 men from infertile couples were investigated. In each individual, the semen characteristic was considered to be different from the postoperative mean value if it was over or below 2 SD of the preoperative mean. Although no relationship was detected with the age of the patient, the duration of infertility or the preoperative semen characteristics, a definite relationship was found between the degree of varicocele and the improvement in each semen characteristic. For improvement of the sperm density, each of the volume and the score count by Johnsen's scale of the affected and unaffected testes and the serum hormone values (LH, FSH and testosterone) showed correlations. Meanwhile, for the improvement of the percentage of progressive motile sperm, correlations were found only with each of the testicular volume on the unaffected side and the serum testosterone level.     

Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading

We aimed to assess the effect of spermatic vein ligation on seminal total antioxidant capacity (TAC) in patients with varicocele. Twenty infertile male patients with varicocele and 20 normal fertile men (control group) were included in the study. All the male patients were diagnosed with primary infertility and varicocele. The patients with varicocele were divided into two groups as nonpalpable (GI) (eight patients) and palpable (GII-III) (12 patients) varicocele groups. All the patients underwent microsurgical spermatic vein ligation. Seminal TAC levels and sperm parameters were evaluated in all the patients. Preoperative sperm count, sperm motility, sperm morphology and seminal TAC levels with equivalent figures 3-6 months after spermatic vein ligation and the same values of the control group were compared. There was a statistically significant increase in the total seminal antioxidant capacity level after spermatic vein ligation, and there was a statistically significant increase in the sperm count, sperm motility and spermatozoa with normal morphology. However, evaluation of the patients for varicocele grade showed a statistically significant increase in the TAC level only in the GII-III varicocele group. Spermatic vein ligation can improve the total seminal antioxidant capacity levels especially in patients with middle and high grade varicocele.     

Ligation of the left spermatic vein in the treatment of male infertility

During a 5 year period 26 selected infertile men underwent surgical correction of varicocele. They were followed up for at least 1 year after surgery. Significant improvement was detected in sperm count and motility (%) of semen analysis after ligation of the internal spermatic vein. Eight of the wives became pregnant after operation. The correction of varicocele by ligation of the internal spermatic vein is an accepted treatment for male infertility.     

腹腔镜保留睾丸动脉精索静脉高位结扎术对睾丸生精功能的影响

目的 探讨腹腔镜下精索内静脉高位结扎同时保留睾丸动脉治疗精索静脉曲张的应用价值.方法 选取156例精索静脉曲张患者,随机分成A、B两组:A组采用腹腔镜下保留睾丸动脉精索静脉高位结扎术,B组采用传统的Palomo术式.比较两组手术前后精液质量参数变化、术后并发症的发生率.结果 A组的手术时间为(32.24士8.35)min,明显短于B组(36.45士9.14)min (P＜0.05),术后阴囊水肿(2.67％)、附睾炎(4％)、睾丸萎缩率(2.67％)明显低于B组(P＜0.05),住院时间、术后复发率比较无统计学意义(P＞0.05);术后精子计数[(43.00±4.3)×106]、精子活率[(65.00±4.55)％]明显高于B组[(37.20士5.45)×106]、[(53.34±6.73)％](P＜0.05),精子密度、精子活力分级比较差异无显著性(P＞0.05).结论 保留睾丸动脉腹腔镜精索内静脉高位结扎术能够明显提高术后精液参数质量,降低阴囊水肿、附睾炎、睾丸萎缩的发生率.     

前腹腔镜精索静脉高位结扎术

目的探讨前腹腔镜精索静脉高位结扎术治疗精索静脉曲张的临床价值。方法回顾分析前腹腔镜精索静脉高位结扎术治疗精索静脉曲张31例患者的临床资料。结果31例手术均获得成功,平均手术时间为43.5 min,术后平均住院3 d,术后随访3~12个月,所有病人临床症状均消失,无复发。术前伴精液常规异常的6例,有5例明显改善,1例无变化。结论前腹腔镜精索静脉高位结扎术损伤小,不干扰腹腔,操作简单,并发症少,术后恢复快,值得推广应用。