精索静脉曲张患者手术前后抗精子抗体的变化及意义

目的 探讨手术治疗精索静脉曲张(VC)对患者血清中抗精子抗体(ASAB)的影响.方法 分析60例左侧Ⅱ.VC患者.20例作为观察对照(A组);20例行保留睾丸动脉的精索静脉高位结扎术(B组);20例行不保留睾丸动脉的精索静脉高位结扎术(C组).酶联免疫法定量测定血清中抗精子抗体IgG、IgM含量.SPSS16.0软件进...     

精索静脉曲张患者双侧睾丸体积差异与精液质量关系的探讨

目的:探讨精索静脉曲张(varicocele,VC)对患者两侧睾丸体积差异的影响及其与精液质量的相关性. 方法:回顾性分析181例VC患者和102例非VC正常生育男性的临床资料,包括VC的程度(Ⅰ～Ⅲ度)和位置(左侧、右侧或双侧),睾丸体积、精液质量分析结果. 结果:181例VC患者中存在睾丸体积差异132例(72.9...     

精索静脉曲张与氧化应激的研究

目的 :研究精索静脉曲张 (VC)时氧化应激的损害机制。　方法 :2 8例VC不育男性 ,行精索内静脉结扎术 ,采精索内静脉血和外周静脉血 ;建立大鼠左侧VC模型 (n =12 ) ,以假手术大鼠为对照组 (n =8) ,术后 3个月取睾丸组织。采用分光光度法检测VC男性血浆及大鼠睾丸组织中一氧化氮 (NO)、一氧化氮合酶 (NOS)、黄嘌呤氧化酶(XO)、乳酸 (Lac)和乳酸脱氢酶 (LDH)含量。　结果 :VC患者精索内静脉血浆中NO、NOS、XO、Lac含量明显高于外周静脉血浆 (P <0 .0 1,P <0 .0 5 ) ,LDH明显降低 (P <0 .0 1)。实验性VC大鼠左侧睾丸组织NO、XO高于对照组 (P <0 .0 1) ,Lac明显降低 (P <0 .0 1)。　结论 :VC时 ,可由于曲张精索静脉血浆中NO、NOS和XO及睾丸组织中NO和XO产生增加 ,以及Lac和LDH含量的变化 ,而导致精子生成障碍或 /和精子活力下降 ,引起男性不育。     

显微精索静脉结扎术治疗精索静脉曲张的疗效评价(附48例报告)

<正>精索静脉曲张(varicocele,VC)是精索内蔓状静脉丛因回流不畅而形成局部静脉扩张、迂曲、延长的病理现象,可以导致患侧睾丸发育滞缓和体积减小、阴囊坠胀疼痛不适及男性不育。精索静脉结扎术是目前应用最普遍的男性不育手术。近年来,随着微创理念的深入,显微精索静脉结扎术因其明显的优势正逐渐被推广应用[1]。我科也于2013年4月开始采用显微精索静脉结扎术治疗VC,效果确切。现报告如下。     

左侧精索静脉曲张伴右侧亚临床精索静脉曲张的不育患者:双侧精索静脉结扎术与单纯左侧精索静脉结扎术的效果比较

研究背景:精索静脉曲张(VC)是引起男性不育的常见原因之一,而精索静脉结扎术对患者症状改善、提高精液质量效果显著.随着B超技术的发展,亚临床的VC患者的诊断率逐渐提高.但对左侧VC伴随右侧亚临床VC而引起不育患者,是采取双侧精索静脉结扎术(BV)还是单纯左侧精索静脉结扎术(LV)对患者症状改善明显一直是医学界的争论焦点.     

显微镜下治疗胡桃夹现象合并左侧精索静脉曲张的临床诊疗体会

目的:探讨显微镜下治疗胡桃夹现象合并左侧精索静脉曲张(VC)的临床疗效。方法:回顾性分析2012年8月至2016年2月收治的31例胡桃夹现象合并左侧VC患者的临床资料,根据有无手术治疗及手术方式不同将其分为3组,11例行显微镜下左侧精索静脉结扎术(显微镜结扎组),11例行经腹股沟左侧精索静脉高位结扎术(高位结扎组),9例行保守治疗(保守治疗组)。比较3组患者治疗前和治疗后6个月的精液质量、精索静脉直径变化情况、睾丸体积变化及两组手术组患者的术后复发情况。所有患者随访6~24(15.3±5.4)个月。结果:显微镜结扎组和高位结扎组术后精液质量参数均较术前有明显改善(P0.05),保守治疗组精液质量参数较前明显下降(P0.05);显微镜结扎组左侧精索静脉直径及乏氏动作时精索静脉直径术后分别为(1.84±0.22)、(2.16±0.25)mm,高位结扎组分别为(2.15±0.43)、(2.44±0.27)mm,较术前明显变窄(P0.05),保守治疗组分别为(2.94±0.24)、(3.77±0.26)mm,较前明显变宽(P0.05)。3组患者左侧睾丸体积治疗后6个月分别为(10.27±1.18)、(9.96±1.72)、(10.48±2.05)ml,与治疗前比较无统计学差异(P0.05);显微镜结扎组术后复发率与高位结扎组比较无统计学差异(P0.05)。结论:血尿、蛋白尿等症状较轻的核桃夹现象合并左侧VC的患者可姑息性行精索静脉结扎术,可改善患者临床症状及提高精液质量,显微镜下治疗胡桃夹现象合并左侧VC是一种良好的手术方式。     

双侧和左侧静脉结扎术治疗左侧临床型并右侧亚临床型精索静脉曲张不育患者疗效的比较

目的 探讨左侧临床型合并右侧亚临床型精索静脉曲张(Varicocele,VC)不育患者双侧精索内静脉结扎术(Bilateral Varicocelectomy,BV)是否优于单纯左侧精索内静脉结扎术(Left Varicocelectomy,LV).方法 将接受BV (n=51)和LV (n=53)的两组患者手术前后参数进行方差分析和x2检验比较.结果 两组患者术前参数有可比性(P＞0.05);术后两组患者精子参数显著改善(P＜0.05),但血清睾酮浓度和睾丸体积无显著性改变(P＞ 0.05),术后两组间参数比较差异无统计学意义(P＞0.05).结论 BV和LV两组疗效相当.     

实验性精索静脉曲张大鼠生精状态评价

目的 通过对大鼠实验性精索静脉曲张(varicocele,VC)模型睾丸生精小管生精上皮结构、性激素水平的分析,探讨精索静脉曲张致不育的机制.方法 40只雄性青春期Wistar大鼠随机分为VC8周组(n=12)、VC12周组(13=12)和相应对照组(分别n=8);左肾静脉部分结扎建立实验性大鼠VC模型.术后8周或12周,分别测量各组大鼠:(1)左侧精索静脉直径、睾丸温度及体质量、睾丸生精小管生精上皮;(2)外周血中促卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)的水平.结果 VC8周和VC12周组大鼠左侧精索静脉明显扩张,与对照相比血管直径差异有统计学意义(P<0.01);VC8和VC12周组大鼠左侧睾丸体质量均低于自体右侧睾丸和对照组睾丸,差异有统计学意义(P<0.05);光镜下,VC组大鼠双侧睾丸生精小管生精上皮精子发生阻滞、细胞脱落和细胞层数减少等,VC12周组损伤程度较VC8周组明显加重,左侧较右侧显著;与对照组相比,VC组大鼠外周血FSH、LH升高,T降低,差异均有统计学意义(P<0.01).结论 本研究提示:VC对大鼠双侧睾丸生精小管生精上皮产生明显的损害作用,并导致大鼠血中T水平降低和FSH、LH水平升高.     

大鼠精索静脉曲张模型的制作及变异分析

目的:观察大鼠睾丸-精索静脉脉管系统解剖及变异情况,探索大鼠精索静脉曲张(varicocele,VC)模型的制作。方法:采用左肾静脉部分结扎法制作80只SD大鼠的VC模型,对模型组及对照组大鼠的睾丸-精索静脉脉管系统进行解剖并绘制图谱。结果:64只成功制成左侧VC模型,平均静脉直径从术前的0.16mm增加到1.3mm。SD大鼠左侧精索静脉走行存在多种类型的变异情况。VC大鼠的睾丸血流由常规的经精索静脉流入下腔静脉变为经3～4个静脉侧枝经膀胱前列腺周围静脉丛流入髂静脉。结论:大鼠VC模型的制作需要考虑多种静脉变异情况,VC使得睾丸静脉血回流通路发生改变。     

彩色多普勒超声在诊断精索静脉曲张中的临床应用

目的探讨彩色多普勒超声在诊断精索静脉曲张（VC）中的临床应用价值。方法回顾性分析103例VC患者的超声声像图表现,重点观察精索静脉内径及血流方向。结果 103例患者中,VC发生于左侧96例（96/103,93.20%）,右侧2例（2/103,1.94%）,双侧5例（5/103,4.85%）。超声检测亚临床型VC 21例（21/103,20.39%）,临床型VCⅠ级26例（26/103,25.24%）,Ⅱ级34例（34/103,33.01%）,Ⅲ级22例（22/103,21.36%）。103例VC患者中,58例接受手术治疗,超声诊断与手术结果符合率达100%（58/58）。结论彩色多普勒超声可准确诊断VC,为临床诊断和治疗VC提供可靠信息,具有重要临床应用价值。     

不育男性双侧Ⅰ度精索静脉曲张对睾丸体积和生殖激素水平的影响

目的 评价不育男性双侧I度精索静脉曲张对睾丸体积和生殖激素水平的影响.方法 185例不育男性双侧I度精索静脉曲张(A组)和149例正常生育男性(B组),比较其睾丸体积、卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T)水平.结果 A组患者两侧睾丸体积均小于B组,但睾丸体积绝对差异和睾丸体积相对差异与B组比较,无统计学意义.A组患者血清FSH水平高于B组,而LH、T与B组相比,差异无统计学意义.结论 不育男性双侧I度精索静脉曲张可导致患者双侧睾丸体积减小,血清FSH水平升高.     

Varicocele in adolescence induces left and right testicular volume loss

OBJECTIVE: To determine the effect of a palpable left-sided varicocele (which in adolescent patients can adversely affect left testicular volume) on right testicular volume with progressive Tanner development and increasing varicocele grade. PATIENTS AND METHODS: The right and left testicular volumes were measured with a standard orchidometer in 70 control patients (mean age 14.6 years, SD 2.2) with no palpable testicular abnormality and in 434 (mean age 14.3 years, SD 2.3) with a palpable left-sided varicocele. Patients with bilateral and right-sided varicoceles were excluded from the study. RESULTS: There was no significant difference between the left and right testicular volumes in the control patients. The testicular volumes of patients with a grade I varicocele were similar to those in control patients. Patients with a grade II varicocele had a significantly smaller left testis than the controls at Tanner stages 4 and 5 (P < or = 0.05). Patients with a grade III varicocele had a significantly smaller left testis than controls at each Tanner stage (P < or = 0.05) and significantly smaller right testis than controls at Tanner stages 4 and 5 (P < or = 0.05). CONCLUSION: The presence of a grade I varicocele in adolescence appears to have no effect on normal testicular growth. Some patients with a grade II varicocele are at risk of left testicular volume loss with time and should have their testicular volume measured annually. Patients with grade III varicocele are at risk of bilateral testicular volume loss; a careful evaluation and early surgical intervention are recommended in this group of patients.     

精索静脉曲张大鼠睾丸低氧与生精细胞凋亡的研究

目的 观察实验精静索静咏曲张(varicocele,VC)大鼠睾丸低氧诱导因子1α(HIF-1α)的表达与睾丸生精细胞凋亡的关系,探讨VC导致不育的病理生理机制.方法 40只大鼠,随机分为3组.建立模型49d后,取其左侧睾丸组织,检测睾丸组织的HIF-1α的表达和生精细胞的凋亡率.结果 westernblot和免疫组化检测的实验组睾丸HIF-1α的表达(2.529±1847,78.57%)显著高于对照组(0.308±0.165,14.29%)和假手术组(0.309±0.164,0.00%)(P<0.05),差异均具统计学意义;实验组睾丸细胞凋亡指数(20.79±5.70)显著低于对照组(0.6±1.4)和假手术组(0.36±0.71)(P<0.001),差异均具统计学意义;实验组睾丸HIF-1α的表达与其细胞凋亡指数呈正相关(r=0.844,P=0.017).结论 VC可引起睾丸低氧,而低氧可以通过诱导生精细胞凋亡来引起睾丸功能的改变.同时,HIF-1α是一种预测生精细胞凋亡程度的有用指标.     

Radiologically assessed testicular changes in infertile males with varicocele

The aim of this study was to assess vascular disturbances in the testis of infertile males associated with varicocele. In total, 124 consecutive male subjects were divided into the following groups: healthy fertile controls (n = 10), Gp1 (n = 28); infertile males with subclinical varicocele, Gp2 (n = 26); infertile males with grade I left varicocele, Gp3 (n = 28); infertile males with grade II left varicocele and Gp4 (n = 32); infertile males with grade III left varicocele. They were subjected to colour duplex for pampiniform plexus and scrotal scintigraphy. There was significant decrease in arterial blood velocity, testicular arterial diameters and testicular perfusion especially in high grade varicocele compared with healthy controls. The mean vein diameter demonstrated significant negative correlation with arterial diameter, arterial blood velocity, perfusion index, testicular size and significant positive correlation with perfusion index. The mean testicular size demonstrated significant positive correlation with arterial blood velocity, perfusion index and nonsignificant correlation with arterial diameter. It is concluded that there are significant decreases in testicular volume, testicular perfusion, blood velocity and testicular artery diameter in infertile males with varicocele.     

Surgical repair of secondary right varicocele in rats with primary left varicocele: effects on fertility, testicular temperature, spermatogenesis, and sperm maturation.

To evaluate whether or not dilation of the right testicular vein is a constant finding in animals with left varicocele and to illustrate its contribution to the detrimental effect of a left varicocele on the right testis, an experimental varicocele model was produced in 40 rats. Ten other rats had a sham operation (group A). Seven weeks after the operation, all 50 rats underwent laparotomy and dilation of both testicular veins was seen in 23 rats, which were randomly assigned to group B (n = 11) and group C (n = 12). One week later, groups A and C underwent sham ligation of the right testicular vein, whereas group B rats underwent resection of this vein. At 84 days after the initial operation, group C rats showed a significant reduction in right epididymal sperm content, motility, and fertilizing capacity, right testicular weight, and right testicular vs. intraabdominal temperature difference when compared with groups A and B. Since surgical repair of the secondary right varicocele improved all the parameters indicating the harmful consequences of the primary left varicocele on the right testis, it appears that dilation of the right testicular vein contributes to the detrimental effect of a left varicocele on the right testis.     

Relationship between testicular volume and presence of varicocele. A comparative study

The varicocele, present in many of the male partners of infertile couples continues to generate controversy, particularly as related to its diagnosis and pathophysiology. The purpose of our study was to determine the relationship between testicular volume and the presence or absence of a varicocele. Testicular volume was determined by the use of an orchiometer; the presence of a varicocele was determined by palpation during a Valsalva maneuver. The patients utilized in the study were those seen in our Andrology and General Urology Clinics; 291 patients with varicoceles and 83 control patients (no evidence of varicocele) were used. The left (mean = 21.4 mL) and right (mean = 23.4 mL) testicular volumes of patients with a varicocele were significantly reduced compared with that of the control group (left, mean = 23.4 mL; right, mean = 26.2 mL; p = 0.0041 and p = 0.002, respectively). The testicular volume corrected on the basis of the body mass (V/m2) also was significantly reduced in the varicocele group compared with controls (left p = 0.007; right p = 0.001). Reduced testicular volume relative to body size may be detected prior to actual demonstration of the stress pattern and the presence of a varicocele, and may be useful in early diagnosis. It is suggested that measurement of testicular volume may be a useful adjunct to routine examination of the infertile male.     

高压氧对精索静脉曲张家兔睾丸组织学影响的实验研究

目的 :通过研究高压氧 (HBO)对精索静脉曲张 (VC)家兔睾丸组织形态和功能的影响 ,进一步探讨VC导致男性不育的发病机理。　方法 :健康成熟雄兔随机分为假手术对照组、VC模型组及高压氧干预的VC模型组 3组 ,每组 8只。部分结扎家兔左腰睾丸干静脉建立VC模型 ,术后用HBO对动物模型进行干预 ,对模型的精液参数 ,睾丸的重量、体积 ,睾丸组织形态以及精曲小管平均直径 (MTDs)、精曲小管生育力指数 (TFI)、Sertoli细胞指标 (SI)进行研究。　结果 :HBO干预动物的精液质量明显改善 ,睾丸重量、体积明显增加 ,与VC模型组比较MTDs差异具有极显著性 (P <0 .0 0 0 1) ,睾丸组织形态基本正常。　结论 :①VC可导致睾丸病理损害和生精功能障碍 ;②慢性缺血、缺氧和微循环障碍可能是VC导致睾丸病理损害、生精功能障碍的首要原因和中心环节 ;③HBO可有效减轻甚至消除VC睾丸组织慢性缺血、低氧状态 ,改善其微循环灌注 ,保护VC睾丸的结构和功能。     

Effects of varicocele after unilateral orchiectomy and sympathectomy

An experimental varicocele was created in the adult rat by partial ligation of the left renal vein. There was a significant bilateral elevation of both testicular blood flow and temperature in the varicocele animals (p less than 0.01). Mean testicular blood flow for control and varicocele animals was 29.6 +/- 1.0 and 39.8 +/- 2.0 ml./min./100 gm. tissue, while mean testicular temperature was 34.4 +/- 0.1 and 35.3 +/- 0.2C, respectively. A left orchiectomy was combined with a left varicocele to determine if the left testis is essential for the right testicular response to a varicocele. Elevation of right testicular blood flow was not altered by left orchiectomy (p less than 0.05); however, right testicular temperature was no longer significantly increased. Mean right testicular blood flow and temperature for this group was 39.0 +/- 1.5 ml./min./100 gm. tissue and 34.2 +/- 0.15C, respectively. A left sympathectomy was combined with a left varicocele to ascertain if the right testicular response to the left varicocele was mediated through a neural pathway. A significant bilateral increase in testicular blood flow was noted with a left sympathectomy alone, and thereby masked the ability to evaluate the right testicular response to the simultaneous left sympathectomy and varicocele. Elevation of right testicular blood flow in response to the left varicocele is independent of the presence of a left testis and any immune response it may stimulate. The role of the sympathetic nervous system as a mediator of the bilateral varicocele effect remains undetermined.     

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.