Wang You-Lian, Jin Ming-Yu, He Chao-Ba, Geng Li-Guo, Wang Wei-Guang, Zhang Zhao-Lei, Qin Zhan, Yuan Shao-Ying
Department of Andrology, Guangdong Provincial Hospital of Chinese Medicine (Zhuhai Branch), Zhuhai, Guangdong 519015, China .
Zhonghua Nan Ke Xue. 2022 Jun;28(6):489-494.
To compared the traditional Chinese medicine Danhong Tongjing Prescription (DTP) and microsurgery in the treatment of varicocele (VC)-induced infertility and investigate the factors influencing the recovery of semen parameters of the patients.
We retrospectively analyzed the clinical data on 218 cases of VC-induced infertility with qi-deficiency and blood-stasis treated with DTP (n = 86) or by microsurgery (n = 132) in our hospital from January 2017 to July 2019, and compared the semen parameters between the two groups of patients after treatment. With age, course of disease, degree of VC, change of the testis volume, estrogen/testosterone (E/T) ratio and levels of FSH and LH as independent variables, and increased semen parameters after treatment as dependent variables, we constructed a multivariate linear regression model and identified statistically significant independent variables.
After treatment, sperm concentration and the percentages of progressively motile sperm (PMS) and morphologically normal sperm (MNS) were obviously improved in both the DTP and microsurgery groups, with statistically significant difference between the two groups in sperm concentration and MNS, but not in PMS. Linear regression analysis showed that the severity of VC was an influencing factor for the recovery of sperm concentration after treatment in the DTP group (r = －11.599, Ra2 = 0.044 9) and the course of VC infertility was a factor affecting the recovery of sperm count in the microsurgery group (r = －1.837, Ra2 = 0.035 7).
DTP is comparable to microsurgery in improving sperm motility while microsurgery is more effective in increasing the percentage of MNS in the treatment of VC-induced infertility. Early surgery is recommended for the treatment of infertility induced by severe bilateral VC, and DTP can be selected for infertility caused by mild or moderate bilateral VC if the patient is unwilling to accept surgery or microsurgery is inaccessible in the hospital.
比较中药丹红通精方（DTP）与显微手术治疗精索静脉曲张（VC）所致不育症的疗效，并探讨影响患者精液参数恢复的因素。
回顾性分析2017年1月至2019年7月我院收治的218例因VC导致的气虚血瘀型不育症患者的临床资料，其中86例采用DTP治疗，132例采用显微手术治疗，比较两组患者治疗后的精液参数。以年龄、病程、VC程度、睾丸体积变化、雌二醇/睾酮（E/T）比值以及促卵泡生成素（FSH）和促黄体生成素（LH）水平作为自变量，治疗后精液参数增加作为因变量，构建多元线性回归模型并确定具有统计学意义的自变量。
治疗后DTP组和显微手术组的精子浓度、前向运动精子（PMS）百分比和形态正常精子（MNS）百分比均明显改善，两组间精子浓度和MNS有统计学差异，PMS无统计学差异。线性回归分析显示，VC严重程度是DTP组治疗后精子浓度恢复的影响因素（r = -11.599，Ra2 = 0.044 9），VC不育病程是显微手术组精子计数恢复的影响因素（r = -1.837，Ra2 = 0.035 7）。
在改善精子活力方面，DTP与显微手术相当，而在治疗VC所致不育症时，显微手术在提高MNS百分比方面更有效。对于重度双侧VC所致不育症，建议早期手术治疗；对于轻度或中度双侧VC所致不育症，若患者不愿接受手术或医院无法开展显微手术，可选择DTP治疗。
