男性不育患者精索静脉曲张的超声诊断研究

目的:探讨高频超声诊断男性不育患者精索静脉曲张(varicocele,VC)的检测指标及其VC导致睾丸体积改变情况。方法:采用高频超声方法对46例正常对照者的精索静脉及178例男性不育患者左侧曲张的精索静脉进行了检测。根据临床及超声检查结果将178例VC患者分为4组,其中亚临床型VC(SVC)组45例,临床型VCⅠ级(VCⅠ)组44例,Ⅱ级(VCⅡ)组48例,Ⅲ级(VCⅢ)组41例。结果:①对照组双侧平静呼吸时精索静脉最大内径(DR)、Valsalva试验时精索静脉最大内径(DV)、最大返流速度(Vmax)、返流持续时间(TR)及睾丸体积差别均无显著性(P>0.05);②VC组与对照组及各级VC组DR、DV、Vmax、TR比较的差别具有显著性(P<0.001);③各VC组左侧睾丸体积小于右侧(P<0.01),VCⅡ、VCⅢ组右侧睾丸体积小于对照组(P<0.05),VCⅢ组左侧睾丸体积小于SVC组(P<0.05)。结论:①高频超声可为男性不育VC患者提供精确的精索静脉内径、血流动力学及睾丸大小等客观指标,有助于男性不育病因的筛选;②单侧VC可引起双侧睾丸体积变小,尤以左侧为甚,亚临床型及临床型VC均可导致患侧睾丸体积缩小,且VC愈严重,睾丸体积愈小。

Application of High Frequency Ultrasound to the Diagnosis of Varicocele in Infertile Males

Objective: To investigate the objective index of the diagnosis of varicocele (VC) in infertile males by ultrasonography and the testis volume changes resulting from varicocele.Methods: Forty-six healthy male volunteers and 178 infertile men with left varicocele were detected by high frequency ultrasound. According to the clinical data and ultrasonographic results, the 178 VC patients were divided into 4 groups, SVC group (45 cases), VC group (44 cases), VC group (48 cases), and VC group (41 cases).Results: The differences in D_(R), D_(V), Vmax, T_(R ) and testis volume between the right and the left sides were not statistically significant in the control group ( P>(0.05)). The differences in D_(R), D_(V), Vmax and T_(R ) between the experimental and control groups as well as among the VC groups were statistically significant (P<(0.001)). The left testis volume was smaller than the right among the VC groups ( P<(0.01)). The right testis volume of the VCand VC groups was significantly smaller than that of the control group ( P<(0.05)), and the left testis volume in the VC group was significantly smaller than that of the SVC group (P<(0.05)). Conclusion: High frequency ultrasound can detect the accurate diameter of the internal spermatic vein, hemodynamic index and testis volume of infertile men with VC, and hence help to screen the causes of male infertility. Unilateral varicocele can cause a volume decrease in both testes, especially in the left. Both unilateral SVC and VC can cause testicular atrophy, and the more serious VC, the higher testicular atrophy.