显微镜下精索静脉结扎术后阴囊温度的变化对男性不育的影响

发布时间：2018-09-05 14:01

【摘要】：研究背景精索静脉曲张(varicocele,VC)是精索内蔓状静脉丛出现异常,从而导致静脉的迂曲、伸长和扩张,在导致男性不育的众多因素中占据重要地位,该病多发生于青壮年男性,发病率约占男性人群的10%--15%。研究发现,VC在男性不育病因中占据首位,主要表现为精子活力差、畸形率高,在睾丸组织活检中查实大多数VC患者精子生成受损。然而,对于VC为何引起男性不育,关于这方面的研究并不十分明确,随着人们研究的不断完善,发现VC引起患者阴囊温度的变化对精子质量有密切关系。精索静脉曲张时,患者的阴囊温度较正常明显升高,造成睾丸及附睾处于较高温度的环境中,影响其生精功能,导致精液质量的下降,造成男性不育。国内外众多专家及学者对阴囊温度升高导致精液质量的下降做了相当多的研究,包括其发病机制及病理结果等。且随着外科技术的发展,VC手术方式的不断更新,不但减轻病人痛苦,而且对精子质量的提升大有益处。然而温度的改变主要影响睾丸还是附睾的功能,其机制尚未阐明,所以本研究选择双侧精索静脉曲张引起不育的患者,利用显微外科技术,观察患者手术前后阴囊温度的变化对精子质量的影响,来作一研究分析。目的探究显微镜下精索静脉结扎术后,对阴囊温度及精子质量的影响,并对阴囊温度的变化与精子质量之间的关系作一研究与探索,为临床中诊治VC引起的男性不育患者提供可靠依据。研究对象和方法收集来自郑州大学第一附属医院2014年11月至2015年4月期间收治的双侧精索静脉曲张临床II°患者190例,失访及资料不完整患者92例,随访期间爱人受孕48例,剩余未怀孕患者完整资料50例。患者年龄在20岁-40岁之间,平均年龄28岁,均为我院门诊及住院病人,病史3月~5年不等,平均1.2年。术后严密随访半年。所有患者手术前后均行阴囊彩超检查、精液分析、阴囊各部位温度的测量等相关资料的记录。且阴囊彩超及体格检查均证实为双侧精索静脉曲张,满足入组及排除标准,利用温度测量仪对50例精索静脉曲张患者手术前后阴囊的根部、中部、底部进行温度测量。采用配对t检验的统计学方法分别对阴囊各部位温度及其精液密度和活力进行统计学分析。结果行显微镜下低位精索静脉结扎术后,患者阴囊各部位(底部、中部、根部)温度较术前明显降低,与手术前相比,差异具有显著性(P0.05);手术前后,阴囊各部位温度的变化与精子活力、密度的变化呈负相关(P0.05);手术后精子密度、活力(A+B)提高,与手术前相比,差异具有显著性(P0.05)。结论1.显微镜下低位精索静脉结扎术后阴囊温度较术前显著降低;2.显微镜下低位精索静脉结扎术后精子质量较术前显著改善,主要表现在精子密度及活力(A+B),对附睾影响较大;3.阴囊温度变化与精子质量具有相关性,呈负相关,具体表现在精索静脉结扎术后阴囊温度的降低提高了精子活力与密度。
[Abstract]:Background Varicocele (VC) is an abnormal varicocele in the spermatic cord, which leads to the tortuosity, elongation and dilation of the veins, and plays an important role in many factors leading to male infertility. The disease occurs mostly in young and middle-aged men, the incidence of which is about 10% - 15% of the male population. However, it is not clear why VC causes male infertility. With the continuous improvement of research, it is found that VC causes changes in scrotal temperature in patients with sperm quality. When varicocele occurs, the scrotal temperature of the patient is significantly higher than that of the normal, resulting in a higher temperature environment in the testis and epididymis, affecting spermatogenesis, resulting in a decline in semen quality, resulting in male infertility. With the development of surgical technology, VC surgery not only relieves the pain of patients, but also greatly benefits the improvement of sperm quality. However, the change of temperature mainly affects the function of testis or epididymis, and its mechanism has not been clarified. Therefore, this study chose bilateral varicocele. Objective To investigate the influence of scrotal temperature on sperm quality after varicocele ligation under microscope and to study the relationship between scrotal temperature and sperm quality. Objectives and methods 190 cases of bilateral varicocele with clinical II degree were collected from the First Affiliated Hospital of Zhengzhou University from November 2014 to April 2015. The average age of the patients was 28 years, ranging from 3 months to 5 years, with an average of 1.2 years. All patients were followed up for 6 months. All patients underwent scrotal color Doppler ultrasonography, semen analysis, and temperature measurements at different parts of the scrotum. The scrotal varicocele was confirmed by color Doppler ultrasound and physical examination, which met the criteria of inclusion and exclusion. The scrotal root, middle and bottom of 50 patients with varicocele were measured by thermometer before and after operation. Results The temperature of scrotum was significantly lower than that before operation (P 0.05), and the temperature of scrotum was negatively correlated with sperm motility and density (P 0.05). Sperm density and sperm motility (A + B) were significantly higher than those before operation (P 0.05). Conclusion 1. The scrotal temperature after low spermatic vein ligation under microscope was significantly lower than that before operation; 2. The sperm quality after low spermatic vein ligation under microscope was significantly improved, mainly in sperm density and sperm motility (A + B), and the influence on epididymis. 3. The scrotal temperature was negatively correlated with sperm quality. The decrease of scrotal temperature after varicocelectomy increased sperm motility and density.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.8

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