手术联合药物治疗附睾结核的疗效及对生育功能影响

目的探讨手术联合药物治疗附睾结核的疗效及对生育功能影响。方法回顾性分析2018年4月至2019年1月昌都民安医院诊治的附睾结核患者的临床资料,其中行手术切除联合药物治疗患者85例(联合组),药物治疗患者42例(药物组),比较分析两组患者治疗有效率、国际勃起功能指数(IIEF-5)、精液参数,同时对联合组进行亚组分析,比较单侧切除附睾(单侧组)和双侧切除附睾(双侧组)两个亚组精液参数的差异。结果联合组结核治疗有效率为100%,高于药物组的95.24%,差异具有统计学意义(P<0.05);联合组治疗前及治疗后IIEF-5评分与药物组比较,差异无统计学意义(P>0.05)。药物组治疗后的精子浓度、精子前向运动率、精子正常形态率与干预前比较,差异无统计学意义(P>0.05)。联合组治疗后的精子浓度、精子前向运动率、精子正常形态率均低于治疗前,差异均具有统计学意义(P<0.05)。治疗后,联合组的精子浓度、精子前向运动率、精子正常形态率均低于药物组,差异均有统计学意义(P<0.05)。手术切除联合药物治疗后,单侧组的精子浓度、精子前向运动率、精子正常形态率与治疗前比较,差异具有统计学意义(P<0.05),而双侧组治疗后的精子浓度、精子前向运动率、精子正常形态率均低于治疗前,差异均具有统计学意义(P<0.05)。治疗后,双侧组的精子浓度、精子前向运动率、精子正常形态率均低于单侧组,差异均具有统计学意义(P<0.05)。结论手术联合药物治疗附睾结核效果好,对性功能影响小,但可能会影响患者的生育功能。因此,建议早期诊断、尽早给予药物治疗,如药物治疗无效才考虑联合手术切除治疗。

Effect of surgery combined with drug treatment on epididymal tuberculosis and its influence on reproductive function

Objective To explore the effect of surgery combined with drug treatment on epididymis tuberculosis and its influence on reproductive function. Methods The clinical data of patients with epididymal tuberculosis hospitalized in Changdu Min′an Hospital from April 2018 to January 2019 was retrospectively analyzed. Among them, 85 patients underwent surgical excision combined with drug treatment(combined group) and 42 patients underwent drug treatment(drug group). The therapeutic efficiency, international index of erectile function(IIEF-5) and semen parameters of the two groups were compared and analyzed. The combined group was divided into unilateral resection subgroup and bilateral resection subgroup to compare changes in the semen parameters. Results The effective rate of tuberculosis treatment in the combined group(100%) was higher than that in the drug group(95.24%), with statistically significant differences(P<0.05). There was no statistically significant difference in the IIEF-5 scores between the combined group and drug group before and after treatment(P>0.05). There was no significant difference in, sperm concentration, forward motility and normal sperm morphology between the two groups(P>0.05). The sperm concentration, forward motility rate and normal morphology rate of sperm in the combined group after intervention were lower than those before intervention, with statistically significant differences(P<0.05). After intervention, the sperm concentration, forward motility rate and normal morphology rate of sperm in the combined group were lower than those in the drug group, with statistically significant differences(P<0.05). There was significant difference in sperm concentration, forward motility rate and normal sperm morphology between before and after treatment in the unilateral subgroup(P<0.05), while the sperm concentration, forward motility rate and normal morphology rate of sperm in bilateral group after intervention were lower than those before intervention, with statistically significant differences(P<0.05). After intervention, the sperm concentration, forward motility rate and normal morphology rate of sperm in bilateral group were lower than those in unilateral group, with statistically significant differences(P<0.05). Conclusions Surgery combined with drug treatment of epididymal tuberculosis has good treatment effect and little impact on the sexual function, but may affect the reproductive function of patients. Therefore, early diagnosis and early drug treatment is suggested and combined surgical resection should be considered if drug treatment is ineffective.