腹股沟下显微外科精索静脉结扎术与经皮栓塞术治疗男性不育症的前瞻性生殖及功能结局比较
Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes.
作者信息
Bou Nasr Elie, Binhazzaa Mouath, Almont Thierry, Rischmann Pascal, Soulie Michel, Huyghe Eric
机构信息
Department of Urology, Toulouse university hospital, 1, avenue Jean Poulhès - TSA 50032, 31059 Toulouse cedex 9, France.
出版信息
Basic Clin Androl. 2017 Jun 8;27:11. doi: 10.1186/s12610-017-0055-x. eCollection 2017.
BACKGROUND
Varicocele is a condition characterized by dilated, tortuous veins within the pampiniform venous plexus of the scrotal sac. Presence of varicocele is associated with an increased risk of alteration of semen parameters. The objective of this study was to compare the current standard in varicocele treatment procedures: sub-inguinal microscopic ligation to percutaneous embolization in terms of semen parameters improvement, fertility, and morbidity at the university hospital of Toulouse (France). Seventy six patients with clinical varicocele, alteration of semen parameters and infertility, underwent either procedure (microsurgery in 49 case performed by a single surgeon and embolization in 27 cases) and were prospectively analyzed. Outcome measures were: semen parameters, spontaneous pregnancies, pain, side effects, recovery time and overall satisfaction. All patients were contacted in January 2015 in order to determine reproductive events.
RESULTS
Preoperatively, there was no difference in clinical and biological items between the two groups. Postoperatively, on the overall population, there was a significant improvement of sperm concentration at 3, 6, 9 and 12 months ( = <0.001, <0.001, 0.012, 0.018) and sperm motility at 6 months ( = 0.002). The sperm concentration was higher at 6 months in the percutaneous embolization group (13.42, vs. 8.1×10/ml; = 0.043). With a median follow-up of 4 years, 27 pregnancies occurred (spontaneous pregnancy rate of 35.5%). There was no significant difference between procedures on the sperm quality, pregnancy rate, and the overall satisfaction. Patients undergoing percutaneous embolization reported a faster recovery time ( = 0.002) and less postoperative pain ( = 0.007).
CONCLUSION
Our study shows that percutaneous embolization seems to be an equivalent alternative to sub-inguinal microscopic ligation in term of sperm quality improvement, pregnancy rate, and overall satisfaction with a slight advantage on post-operative morbidity.
背景
精索静脉曲张是一种以阴囊内蔓状静脉丛中静脉扩张、迂曲为特征的病症。精索静脉曲张的存在与精液参数改变的风险增加相关。本研究的目的是在法国图卢兹大学医院，就精液参数改善、生育能力和发病率方面，比较精索静脉曲张治疗程序的当前标准：腹股沟下显微结扎术与经皮栓塞术。76例患有临床精索静脉曲张、精液参数改变和不育症的患者接受了其中一种手术（49例由一名外科医生进行显微手术，27例进行栓塞术），并进行了前瞻性分析。观察指标包括：精液参数、自然妊娠、疼痛、副作用、恢复时间和总体满意度。2015年1月联系了所有患者以确定生殖事件。
结果
术前，两组在临床和生物学指标上无差异。术后，在总体人群中，3、6、9和12个月时精子浓度有显著改善（P<0.001，<0.001，0.012，0.018），6个月时精子活力有显著改善（P = 0.002）。经皮栓塞组6个月时精子浓度更高（13.42对8.1×10/ml；P = 0.043）。中位随访4年，发生了27例妊娠（自然妊娠率为35.5%）。两种手术在精子质量、妊娠率和总体满意度方面无显著差异。接受经皮栓塞术的患者报告恢复时间更快（P = 0.002）且术后疼痛更少（P = 0.007）。
结论
我们的研究表明，在改善精子质量、妊娠率和总体满意度方面，经皮栓塞术似乎是腹股沟下显微结扎术的等效替代方法，在术后发病率方面有轻微优势。
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