睾丸癌男性患者睾丸切除术前和术后的精液质量与生殖激素

Semen quality and reproductive hormones before and after orchiectomy in men with testicular cancer.

作者信息

Petersen P M, Skakkebaek N E, Rørth M, Giwercman A

机构信息

Department of Growth and Reproduction, Finsencenter, Copenhagen University Hospital, Rigshospitalet, Denmark.

出版信息

J Urol. 1999 Mar;161(3):822-6.

PMID:10022693

Abstract

PURPOSE

We clarify the impact of removal of the tumor bearing testis on semen quality and reproductive hormones in men with testicular cancer.

MATERIALS AND METHODS

Semen quality and levels of reproductive hormones were investigated in 48 men before and after orchiectomy for testicular cancer. Semen analysis was done in 35 of these men and hormone analyses were done in 47. The hormone data of patients with (14) or without (33) elevated values of human chorionic gonadotropin (HCG) were analyzed separately.

RESULTS

Median sperm concentration and total sperm count decreased from 17 x 10(6)/ml. (range 0 to 117) and 39 x 10(6) (0 to 433), respectively, before to 7 x 10(6)/ml. (0 to 69) and 30 x 10(6) (0 to 200), respectively, after orchiectomy. After orchiectomy sperm concentration was decreased in 30 of 35 men (p = 0.001) and azoospermia developed in 3 (9%). In men without detectable HCG median follicle-stimulating hormone levels increased (p <0.001) from 5.7 IU/l. (range 0.01 to 30) before to 10.0 IU/l. (4.6 to 48) after orchiectomy in 33 of 33 patients. Median inhibin B significantly decreased (p = 0.003) from 108 pg./l. (range 60 to 193) before to 95 pg./l. (less than 20 to 141) after orchiectomy. Median luteinizing hormone increased significantly from 3.1 IU/l. (range 1.1 to 9.9) before to 5.2 IU/l. (2.1 to 27) after treatment (p <0.001). Testosterone and sex hormone-binding globulin did not change significantly after orchiectomy. Patients with detectable serum HCG before orchiectomy had a considerable increase in follicle-stimulating hormone after orchiectomy, and a concomitant decrease in testosterone and estradiol.

CONCLUSIONS

Semen quality was poor at diagnosis and deteriorated further after orchiectomy compared with pretreatment values. Our findings indicate that in some patients the most appropriate time for cryopreservation of semen is before orchiectomy. Androgen production was maintained by increased luteinizing hormone stimulation after orchiectomy.

摘要

目的

我们阐明了切除患肿瘤睾丸对睾丸癌男性精液质量和生殖激素的影响。

材料与方法

对48例睾丸癌患者在睾丸切除术前和术后的精液质量和生殖激素水平进行了研究。其中35例患者进行了精液分析，47例患者进行了激素分析。对人绒毛膜促性腺激素（HCG）值升高（14例）或未升高（33例）的患者的激素数据分别进行了分析。

结果

精子浓度中位数和总精子数分别从术前的17×10⁶/ml（范围0至117）和39×10⁶（0至433）降至术后的7×10⁶/ml（0至69）和30×10⁶（0至200）。睾丸切除术后，35例患者中有30例精子浓度下降（p = 0.001），3例（9%）出现无精子症。在术前未检测到HCG的男性中，33例患者的促卵泡激素水平中位数从术前的5.7 IU/l（范围0.01至30）升高至术后的10.0 IU/l（4.6至48）（p <0.001）。抑制素B中位数从术前的108 pg./l（范围60至193）显著下降至术后的95 pg./l（小于20至141）（p = 0.003）。促黄体生成素中位数从术前的3.1 IU/l（范围1.1至9.9）显著升高至治疗后的5.2 IU/l（2.1至27）（p <0.001）。睾丸切除术后睾酮和性激素结合球蛋白无显著变化。术前血清HCG可检测到的患者在睾丸切除术后促卵泡激素显著升高，同时睾酮和雌二醇降低。