精索静脉曲张显微镜手术的临床疗效及对精液微生态的影响
发布时间：2019-03-20 11:45
【摘要】：目的:探究显微镜精索静脉结扎术对精索静脉曲张患者精液参数的影响及精索静脉曲张对于精液微生态的影响。方法:从2015年3月至2016年12月,将90例在浙江大学医学院附属第一医院诊断为精索静脉曲张的患者纳入临床疗效研究,其中31例纳入微生态研究,24位正常男性志愿者纳入对照组。所有人员均进行精液、血液检查并收集样本。所有精索静脉曲张患者在术后3月及术后6月进行精液检查及精液样本采集,通过对16S rRNA的V3-4区进行二代测序来观察微生物菌落情况。结果:90例精索静脉曲张患者术后3月精子活率、精子活力、精子浓度及精子总数较术前均有显著提升(分别为 30.12 ± 17.34%VS 45.68±21.21%,p0.0001;23.92±13.96%VS 37.36±19.33%,p0.0001;41.56±40.06百万/ml VS 56.49±60.22百万/ml,p=0.03;148.54±157.96百万VS 221.82±241.66百万,p=0.005),术后6月较术前亦显著提升(分别为30.12±17.34%VS 43.40±17.09%,p=0.0003;23.92±13.96%VS 36.07±14.37%,p=0.0005;41.56±40.06百万/ml VS 49.84±26.82百万/ml,p=0.008;148.54±157.96百万VS 216.99±155.89百万,p=0.02),但术后3月与术后6月相比所有的精液参数均未见明显改变。术前精液参数正常组,术前与术后3月精液参数无明显差异。术前精液异常组,精液参数,精子活率、精子活力、精子浓度及精子总数较均有显著性提升(分别为20.53±9.55%VS 42.46±21.23%,p0.0001;16.24±7.37%VS 34.21 士 19.53%,p0.0001;30.57±24.32百万/ml VS 44.4±28.02百万/ml,p=0.002;119.59±118.69百万 VS201.98±154.2百万,p=0.001)。微生态研究中,精索静脉曲张患者的物种多样性丰度明显高于正常男性,且精液中的Bacteroidetes(拟杆菌门)与Firmicutes(厚壁菌门)(p0.05)含量更高,Proteobaceria(变形菌门)(p0.05)含量更低。Clostridiales(梭菌目),Pseudomonadales(假单胞菌目),Corynebactriales(棒状杆菌科),Anaerococcus(厌氧球菌属)和 Pseudomonas(假单胞菌属)在精索静脉曲张患者精液中含量明显升高,可能与炎症因素相关。精索静脉曲张术后患者的微生态有向正常人群变化的趋势。结论:显微镜精索静脉结扎术能够显著提升术前精液异常患者的精液质量。术后3月与术后6月精液参数未见明显异常,仍需要更长时间随访及更大的样本量来验证。术前精液质量异常的患者手术治疗效果更佳。精索静脉曲张患者精液微生态存在明显改变,这可能是一种导致精索静脉曲张患者精液质量下降的新机制。
[Abstract]:Aim: to investigate the effect of microsurgical ligation of spermatic vein on semen parameters of patients with varicocele and the effect of varicocele on sperm microecology. Methods: from March 2015 to December 2016, 90 patients with varicocele diagnosed as varicocele in the first affiliated Hospital of Medical College of Zhejiang University were enrolled in the clinical efficacy study, and 31 of them were included in microecological study. Twenty-four normal male volunteers were enrolled in the control group. All personnel performed semen, blood tests and collected samples. All patients with varicocele were examined by semen examination and semen samples were collected at 3 months and 6 months after operation. The microbial colonies were observed by sequencing the V3-4 region of 16s rRNA. Results: the sperm motility, sperm concentration and sperm count were significantly increased in 90 patients with varicocele 3 months after operation (30.12 卤17.34%VS 45.68 卤21.21%, p0.0001, respectively). 23.92 卤13.96%VS 37.3636 卤19.33%, p0.0001 脳 41.56 卤40.06 million / ml VS 56.49 卤60.22 million / ml,p=0.03; 148.54 卤157.96 million VS 221.82 卤241.66 million, p < 0.005), and also increased significantly 6 months after operation (30.12 卤17.34%VS 43.40,23.92 卤13.96%VS 36.07 卤14.37%, p = 0.0005, respectively) compared with that before the operation (30.12 卤17.34%VS 43.40,23.92 卤13.96%VS 36.07 卤14.37%, p = 0.0005, respectively). 41.56 卤40.06 million / ml VS 49.84 卤26.82 million / ml,p=0.008;148.54 卤157.96 million VS 216.99 卤155.89 million, p = 0.02), but there were no significant changes in semen parameters 3 months after operation and 6 months after operation. There was no significant difference in semen parameters between pre-operation and 3 months after operation in the group of normal semen parameters before operation. In the abnormal semen group, semen parameters, sperm motility, sperm concentration and sperm count were significantly increased (20.53 卤9.55%VS 42.46 卤21.23%, p0.0001, respectively). 16.24 卤7.37%VS 34.21 卤19.53%, p0.0001 卤24.32 million / ml VS 44.4卤 28.02 million / ml,p=0.002;119.59 卤118.69 million VS201.98 卤154.2 million, p < 0.001). In microecological study, the abundance of species diversity in patients with varicocele was significantly higher than that in normal men, and the contents of Bacteroidetes and Firmicutes in semen were higher than those in normal men. Proteobaceria (Proteus) (p0.05) was lower, Clostridiales (Clostridiales) (Clostridiales,), Pseudomonadales (,), Corynebactriales (, Corydae), The levels of Anaerococcus (anaerobic cocci) and Pseudomonas (Pseudomonas) in semen of patients with varicocele increased significantly, which may be related to inflammatory factors. The microecology of patients with varicocele after varicocele has a tendency to change to the normal population. Conclusion: microsurgical ligation of spermatic vein can significantly improve the semen quality of patients with abnormal semen before operation. After 3 months and 6 months after operation, there was no significant abnormality in semen parameters, which still required longer follow-up and larger sample size to verify. Surgical treatment of patients with abnormal semen quality before operation is better. There are obvious changes in sperm microecology in patients with varicocele, which may be a new mechanism leading to the decline of semen quality in patients with varicocele.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.8
，
本文编号：2444184
[Abstract]:Aim: to investigate the effect of microsurgical ligation of spermatic vein on semen parameters of patients with varicocele and the effect of varicocele on sperm microecology. Methods: from March 2015 to December 2016, 90 patients with varicocele diagnosed as varicocele in the first affiliated Hospital of Medical College of Zhejiang University were enrolled in the clinical efficacy study, and 31 of them were included in microecological study. Twenty-four normal male volunteers were enrolled in the control group. All personnel performed semen, blood tests and collected samples. All patients with varicocele were examined by semen examination and semen samples were collected at 3 months and 6 months after operation. The microbial colonies were observed by sequencing the V3-4 region of 16s rRNA. Results: the sperm motility, sperm concentration and sperm count were significantly increased in 90 patients with varicocele 3 months after operation (30.12 卤17.34%VS 45.68 卤21.21%, p0.0001, respectively). 23.92 卤13.96%VS 37.3636 卤19.33%, p0.0001 脳 41.56 卤40.06 million / ml VS 56.49 卤60.22 million / ml,p=0.03; 148.54 卤157.96 million VS 221.82 卤241.66 million, p < 0.005), and also increased significantly 6 months after operation (30.12 卤17.34%VS 43.40,23.92 卤13.96%VS 36.07 卤14.37%, p = 0.0005, respectively) compared with that before the operation (30.12 卤17.34%VS 43.40,23.92 卤13.96%VS 36.07 卤14.37%, p = 0.0005, respectively). 41.56 卤40.06 million / ml VS 49.84 卤26.82 million / ml,p=0.008;148.54 卤157.96 million VS 216.99 卤155.89 million, p = 0.02), but there were no significant changes in semen parameters 3 months after operation and 6 months after operation. There was no significant difference in semen parameters between pre-operation and 3 months after operation in the group of normal semen parameters before operation. In the abnormal semen group, semen parameters, sperm motility, sperm concentration and sperm count were significantly increased (20.53 卤9.55%VS 42.46 卤21.23%, p0.0001, respectively). 16.24 卤7.37%VS 34.21 卤19.53%, p0.0001 卤24.32 million / ml VS 44.4卤 28.02 million / ml,p=0.002;119.59 卤118.69 million VS201.98 卤154.2 million, p < 0.001). In microecological study, the abundance of species diversity in patients with varicocele was significantly higher than that in normal men, and the contents of Bacteroidetes and Firmicutes in semen were higher than those in normal men. Proteobaceria (Proteus) (p0.05) was lower, Clostridiales (Clostridiales) (Clostridiales,), Pseudomonadales (,), Corynebactriales (, Corydae), The levels of Anaerococcus (anaerobic cocci) and Pseudomonas (Pseudomonas) in semen of patients with varicocele increased significantly, which may be related to inflammatory factors. The microecology of patients with varicocele after varicocele has a tendency to change to the normal population. Conclusion: microsurgical ligation of spermatic vein can significantly improve the semen quality of patients with abnormal semen before operation. After 3 months and 6 months after operation, there was no significant abnormality in semen parameters, which still required longer follow-up and larger sample size to verify. Surgical treatment of patients with abnormal semen quality before operation is better. There are obvious changes in sperm microecology in patients with varicocele, which may be a new mechanism leading to the decline of semen quality in patients with varicocele.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.8
，
本文编号：2444184
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