Jarow J P, Ogle S R, Eskew L A
Department of Urology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina, USA.
J Urol. 1996 Apr;155(4):1287-90.
We determined whether repair of subclinical varicoceles detected by scrotal duplex ultrasonography results in significant seminal improvement and identified the best ultrasonographic criteria to use in the selection of patients for subclinical varicocelectomy.
Of 256 consecutive infertile men being evaluated by physical examination and color duplex scrotal ultrasonography 76 underwent varicocele repair and were followed with serial semen analyses. All subclinical varicoceles were confirmed by venography. The outcome of varicocelectomy was determined by changes in total motile sperm count and compared among patients with different clinical grades of varicoceles and ultrasonographically measured in veins sizes.
A significant overlap was observed between ultrasonographically measured venous diameter and clinical grade of varicocele. There was no correlation between venous diameter and postoperative outcome when controlled for clinical grade. Significant postoperative improvement in semen parameters was noted in 67% of patients with clinical and only 41% with subclinical varicocelectomy (p<0.05). The best ultrasonographic cutoff to predict a positive outcome after subclinical varicocelectomy was venous diameter greater than 3mm. Patients with larger clinical varicoceles had greater postoperative seminal improvement than those with small or subclinical varicoceles regardless of baseline sperm count.
Varicocele size has a direct impact on the probability and amount of seminal improvement after varicocelectomy. Outcome following subclinical varicocelectomy is significantly less than after repair of clinical varicoceles. Although 41% of patients with subclinical varicoceles had significant postoperative improvement in semen parameters, an equal number were worse postoperatively and, thus, mean sperm count was unchanged for the group. The results of our study suggest that subclinical varicocelectomy is of questionable benefit.
我们确定通过阴囊双功超声检测到的亚临床精索静脉曲张修复是否能显著改善精液质量，并确定在选择亚临床精索静脉曲张切除术患者时使用的最佳超声标准。
在256名连续接受体格检查和阴囊彩色双功超声评估的不育男性中，76人接受了精索静脉曲张修复，并进行了系列精液分析。所有亚临床精索静脉曲张均经静脉造影证实。精索静脉曲张切除术的结果通过总活动精子数的变化来确定，并在不同临床分级的精索静脉曲张患者之间以及通过超声测量静脉大小进行比较。
超声测量的静脉直径与精索静脉曲张的临床分级之间存在显著重叠。在控制临床分级后，静脉直径与术后结果之间无相关性。临床精索静脉曲张切除术患者中67%的精液参数术后有显著改善，而亚临床精索静脉曲张切除术患者中只有41%（p<0.05）。预测亚临床精索静脉曲张切除术后阳性结果的最佳超声临界值是静脉直径大于3mm。无论基线精子计数如何，临床精索静脉曲张较大的患者术后精液改善程度均大于精索静脉曲张较小或亚临床的患者。
精索静脉曲张大小对精索静脉曲张切除术后精液改善的可能性和程度有直接影响。亚临床精索静脉曲张切除术后的结果明显低于临床精索静脉曲张修复术后。虽然41%的亚临床精索静脉曲张患者术后精液参数有显著改善，但同样数量的患者术后情况更差，因此该组平均精子计数没有变化。我们的研究结果表明，亚临床精索静脉曲张切除术的益处值得怀疑。
