Takahara M, Ichikawa T, Shiseki Y, Nakamura T, Shimazaki J
Department of Urology, School of Medicine, Chiba University, Japan.
Int J Urol. 1996 Jul;3(4):282-5. doi: 10.1111/j.1442-2042.1996.tb00535.x.
Although several studies indicate that larger varicoceles are associated with greater impairment of spermatogenesis, others suggest that the response to surgery is independent of varicocele size. In order to elucidate these seeming contradictions, correlations between the preoperative evaluation of varicoceles and improvement in semen quality after varicocelectomy were investigated.
Forty men with left unilateral varicocele, followed for at least 6 months after varicocelectomy, were included in this study. The relationships between the grade of varicocele by palpation, Doppler examination, ultrasound, or scintigraphy were correlated with a postoperative improvement in sperm density or sperm motility.
Greater improvement in sperm density was observed in the patients with a large varicocele graded by palpation or measured by ultrasound, and greater improvement in sperm motility was observed in the patients with high uptake of radioactivity in the left side by scrotal scintigraphy.
An improvement in semen quality after varicocelectomy is greater in patients with a large varicocele than in the patients with a small one. The significance of surgical repair of a small varicocele should be reconsidered.
尽管多项研究表明较大的精索静脉曲张与精子发生的更严重损害相关，但其他研究表明手术反应与精索静脉曲张大小无关。为了阐明这些明显的矛盾，研究了精索静脉曲张的术前评估与精索静脉结扎术后精液质量改善之间的相关性。
本研究纳入了40例左侧单侧精索静脉曲张患者，这些患者在精索静脉结扎术后至少随访6个月。通过触诊、多普勒检查、超声或闪烁扫描确定的精索静脉曲张分级与术后精子密度或精子活力的改善之间的关系。
通过触诊分级或超声测量为大精索静脉曲张的患者精子密度改善更大，阴囊闪烁扫描显示左侧放射性摄取高的患者精子活力改善更大。
精索静脉结扎术后，大精索静脉曲张患者的精液质量改善比小精索静脉曲张患者更大。应重新考虑小型精索静脉曲张手术修复的意义。
