【摘要】：目的:精索靜脈曲張(VC varicocele)是引起男性不育的重要因素之一,在不育男性中發(fā)病率很高,世界衛(wèi)生組織把精索靜脈曲張列為男性不育的首要原因。目前,對于精索靜脈曲張引起男性不育的機制尚不完全明確,本研究通過測量睪丸動脈及精索靜脈血流流速、陰囊溫度、精液質(zhì)量,探討睪丸動脈及精索靜脈血流流速與陰囊溫度的關系,進一步了解睪丸動脈及精索靜脈血流流速與精液質(zhì)量的關系,對認識精索靜脈曲張引起男性不育的機制有一定的參考價值。方法:納入鄭州大學第一附屬醫(yī)院男科門診2015年8月至2016年11月就診的247例男性不育患者,180例合并有左側(cè)精索靜脈曲張患者設定為實驗組,67例無精索靜脈曲張的不育患者設定為對照組,實驗組及對照組患者均經(jīng)彩超證實。在180例左側(cè)精索靜脈曲張患者中,34例為Ⅰ°曲張,120例為Ⅱ度曲張,26例為Ⅲ度曲張。測量兩組睪丸動脈血流流速、精索靜脈血流流速、陰囊溫度及精液質(zhì)量(A級+B級),對兩組測量指標進行對比研究;再給予曲張組患者行顯微鏡下精索靜脈結(jié)扎術(shù),術(shù)后3個月測量精液質(zhì)量、陰囊溫度,對術(shù)前及術(shù)后測量指標進行對比研究。結(jié)果:VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)睪丸動脈血流流速分別為(13.80±2.82)cm/s、(13.76±2.65)cm/s、(13.81±2.39)cm/s,對照組為(14.00±2.45)cm/s,二者無明顯差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)精索內(nèi)靜脈血流流速分別為(2.78±0.53)cm/s、(2.65±0.62)cm/s、(2.48±0.50)cm/s,對照組為(3.49±0.40)cm/s,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)左側(cè)睪丸溫度分別為(36.58±0.22)℃、(36.66±0.22)℃、(36.95±0.23)℃,對照組左側(cè)為(36.15±0.18)℃,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)右側(cè)睪丸溫度分別為(36.53±0.22)℃、(36.65±0.22)℃、(36.93±0.23)℃,對照組右側(cè)為(36.15±0.17)℃,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)精子活力分別為(32.74±1.30)%、(30.58±1.28)%、(25.37±1.54)%,對照組精子活力(36.82±1.68)%,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)術(shù)后精液質(zhì)量分別為(38.82±1.29)%、(40.64±1.29)%、(31.56±1.29)%,術(shù)前精液質(zhì)量分別為(32.74±1.30)%、(30.58±1.30)%、(25.37±1.54)%,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)術(shù)后右側(cè)陰囊溫度分別為(36.20±0.21)℃、(36.20±0.21)℃、(36.32±0.21)℃,術(shù)前右側(cè)陰囊溫度分別為(36.53±0.22)℃、(36.93±0.22)℃、(36.65±0.23)℃,二者有統(tǒng)計學差異(P0.05);VC患者組(Ⅰ度、Ⅱ度、Ⅲ度)術(shù)后左側(cè)陰囊溫度分別為(36.20±0.21)℃,(36.21±0.21)℃、(36.34±0.21)℃,術(shù)前左側(cè)陰囊溫度分別為(36.58±0.22)℃(36.95±0.22)℃、(36.66±0.23)℃,二者有統(tǒng)計學差異(P0.05)。結(jié)論:VC患者組精索靜脈血液回流速度較對照組緩慢,可能是引起睪丸溫度增高的原因之一,陰囊溫度升高影響精子的生成及成熟,進而造成了精液質(zhì)量下降,引起男性不育。精索靜脈血流速度緩慢可能是精索靜脈曲張引起男性不育的原因之一。
[Abstract]:Objective: varicocele (VC varicocele) is one of the important factors that cause male infertility. The incidence of varicocele is very high in infertile men. The World Health Organization lists varicocele as the primary cause of male infertility. At present, the mechanism of male infertility caused by varicocele is not completely clear. The blood flow velocity of testicular artery and varicocele, scrotum temperature, semen quality were measured. To investigate the relationship between the blood flow velocity of testicular artery and spermatic vein and scrotal temperature, and the relationship between blood flow velocity of testicular artery and spermatic vein and semen quality. It has certain reference value for understanding the mechanism of male infertility caused by varicocele. Methods: from August 2015 to November 2016, 247 male infertile patients with varicocele were enrolled in the andrology clinic of the first affiliated Hospital of Zhengzhou University. 180 patients with varicocele were selected as experimental group (67 cases without varicocele). The infertile patients were set as the control group, The patients in the experimental group and the control group were confirmed by color Doppler ultrasound. Of 180 patients with varicocele on the left side, 34 cases were 鈪，

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