摘要
目的探讨经导管血管栓塞术对精索静脉曲张患者生育力的影响。方法对37例Ⅱ度以上且伴有精液异常的精索静脉曲张患者使用鱼肝油酸钠加明胶海绵颗粒行选择性精索静脉栓塞术。所有患者均每3个月随访1次,共12个月,观察其阴囊皮肤温度、睾丸体积、精液分析等情况。结果37例患者术后精索静脉曲张消失,均未见复发。左侧睾丸体积从术前的(15．11±2．33)mm3至术后9、12个月时分别增加为(16．38±1．86)mm3(P<0．05)和(16．61±1．81)mm3(P<0．01),右侧睾丸体积术后各期与术前相比差异均无统计学意义(P>0．05)。阴囊左侧皮肤温度从术前的(33．61±0．75)℃至术后3个月降低为(32．28±0．61)℃(P<0．01),但术后3个月以后无明显变化(P>0．05);阴囊右侧皮肤温度术后各期与术前相比差异均无统计学意义(P>0．05)。精子密度从术前的(14．37±8．61)×106个／ml至术后3、6个月时分别增加为(37．61±23．10)×106个／ml(P< 0．01)和(50．93±36．25)×106个／ml(P<0．01)。精子存活率从术前的(44．02±9．86)％至术后3、6个月时分别增加为(65．85±5．99)％(P<0．01)和(69．54±8．51)％(P<0．01)。正常形态精子百分率从术前的(61．45±11．93)％至术后3个月时增加为(72．02±5．21)％(P<0．01)。A+B级精子百分率从术前的(18．05±3．83)％至术后3、6和9个月时分别增加为(30．13±5．95)％(P<0．01)、(33．61±5．34)％和(36．45±6．08)％(P<0．01)。生育力指数从术前的14．73±5．97至术后3、6个月时分别增加为73．76±7．01(P<0．01)和100．62±9．95(P<0．01),但精子密度、精子存活率和生育力指数在术后6个月以后差异无统计学意义(P>0．05),正常形态精子百分率在术后3个月以后无明显变化(P>0．05),A+B级精子百分率在术后9个月以后无明显变化(P>0．05)。精液量和精液pH值于术前及术后各期之间相比差异均无统计学意义(P>0．05)。结论选择性精索静脉栓塞术可提高精索静脉曲张患者的生育力。
Objective To study the changes of fertility after selective internal spermatic vein embolization in varicocele. Methods Thirty-seven varicocele patients with semen abnormity had been undergone selective internal spermatic vein embolization with natrii morrhuas and gelatin sponge particle. Every patient had been followed up at three monthly intervals for twelve months. At each visit, scrotal thermography, both testicular volume, semen analysis were observed. Results Varicocele of all 37 patients vanished after embolization and there were no recurrence in the follow-up periods. The left testicular volumes rose from （ 15. 11 ± 2. 33 ） mm^3 preoperative to （ 16. 38 ± 1. 86 ） mm^3 at 9 months after embolization（ P 〈 0. 05） and （ 16. 61 ± 1.81 ）mm^3 at 12 months after embolization （ P 〈 0. 01 ）. The right testicular volumes had no significant difference among preoperative and every follow-up period （ P 〉 0. 05 ）. The left scrotal thermography decreased markedly from （33.61 ± 0. 75 ） ℃ preoperative to （ 32. 28 ± 0. 61 ） ℃ at 3 months after embolization （ P 〈 0. 05 ）, and had no significant change since 3 months after embolization （ P 〉 0. 05 ）. The right scrotal thermography had no significant difference among preoperative and every follow-up period （ P 〉 0. 05）. Semen density increased from （ 14. 37 ± 8. 61 ） × 10^6/ml preoperative to （ 37. 61 ± 23.10） × 10^6/ml at 3 months after embolization （ P 〈 0. 01 ） and （ 50. 93 ± 36. 25 ） × 10^6/ml at 6 months after embolization （ P 〈 0. 01 ） . Sperm viability increased from （ 44.02 ± 9. 86 ） % preoperative to （ 65.85 ± 5.99） % at 3 months after embolization （ P 〈 0.01 ） and （ 69. 54 ± 8.51 ） % at 6 months after embolization （P〈0.01）. Morphological percentage of normal sperm rose from （61.45 ± 11.93）% preoperative to （ 72.02 ± 5.21 ） % at 3 months after embolization （ P 〈 0. 01 ）. A ＋ B degree spermic percentage rose from （ 18.05 ± 3.83 ） % preoperative to （ 30. 13 ± 5.95 ） % at 3 months after embolization （ P 〈 0. 01 ） and （33.61 ± 5.34）% at 6 months after embolization （P〈0.01） and （36.45 ± 6.08）% at 9 months after embolization （ P 〈 0. 01 ）. Fertility index rose from 14. 73 ± 5.97 preoperative to 73.76 ± 7.01 at 3 months after embolization（P 〈 0. 01 ） and 100. 62 ± 9.95 at 6 months after embolization （ P 〈 0. 01 ） . Semen density, sperm viability, and fertility index had no significant change since 6 months after embolization （ P 〉 0. 05）. Morphological percentage of normal sperm had no significant change since 3 months after embolization （P 〉 0. 05）. A ＋ B degree spermic percentage has no significant change since 9 months after embolization （P 〉 0. 05 ）. Semen volume and value of pH had no significant difference among preoperative and every follow-up period （ P 〉 0. 05 ）. Conclusion Selective internal spermatic vein embolization can improve the fertility in varicocele patients.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2006年第7期748-751,共4页
Chinese Journal of Radiology
