精索靜脈曲張顯微鏡手術(shù)的臨床療效及對(duì)精液微生態(tài)的影響
發(fā)布時(shí)間：2019-03-20 11:45
【摘要】：目的:探究顯微鏡精索靜脈結(jié)扎術(shù)對(duì)精索靜脈曲張患者精液參數(shù)的影響及精索靜脈曲張對(duì)于精液微生態(tài)的影響。方法:從2015年3月至2016年12月,將90例在浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院診斷為精索靜脈曲張的患者納入臨床療效研究,其中31例納入微生態(tài)研究,24位正常男性志愿者納入對(duì)照組。所有人員均進(jìn)行精液、血液檢查并收集樣本。所有精索靜脈曲張患者在術(shù)后3月及術(shù)后6月進(jìn)行精液檢查及精液樣本采集,通過(guò)對(duì)16S rRNA的V3-4區(qū)進(jìn)行二代測(cè)序來(lái)觀察微生物菌落情況。結(jié)果:90例精索靜脈曲張患者術(shù)后3月精子活率、精子活力、精子濃度及精子總數(shù)較術(shù)前均有顯著提升(分別為 30.12 ± 17.34%VS 45.68±21.21%,p0.0001;23.92±13.96%VS 37.36±19.33%,p0.0001;41.56±40.06百萬(wàn)/ml VS 56.49±60.22百萬(wàn)/ml,p=0.03;148.54±157.96百萬(wàn)VS 221.82±241.66百萬(wàn),p=0.005),術(shù)后6月較術(shù)前亦顯著提升(分別為30.12±17.34%VS 43.40±17.09%,p=0.0003;23.92±13.96%VS 36.07±14.37%,p=0.0005;41.56±40.06百萬(wàn)/ml VS 49.84±26.82百萬(wàn)/ml,p=0.008;148.54±157.96百萬(wàn)VS 216.99±155.89百萬(wàn),p=0.02),但術(shù)后3月與術(shù)后6月相比所有的精液參數(shù)均未見(jiàn)明顯改變。術(shù)前精液參數(shù)正常組,術(shù)前與術(shù)后3月精液參數(shù)無(wú)明顯差異。術(shù)前精液異常組,精液參數(shù),精子活率、精子活力、精子濃度及精子總數(shù)較均有顯著性提升(分別為20.53±9.55%VS 42.46±21.23%,p0.0001;16.24±7.37%VS 34.21 士 19.53%,p0.0001;30.57±24.32百萬(wàn)/ml VS 44.4±28.02百萬(wàn)/ml,p=0.002;119.59±118.69百萬(wàn) VS201.98±154.2百萬(wàn),p=0.001)。微生態(tài)研究中,精索靜脈曲張患者的物種多樣性豐度明顯高于正常男性,且精液中的Bacteroidetes(擬桿菌門)與Firmicutes(厚壁菌門)(p0.05)含量更高,Proteobaceria(變形菌門)(p0.05)含量更低。Clostridiales(梭菌目),Pseudomonadales(假單胞菌目),Corynebactriales(棒狀桿菌科),Anaerococcus(厭氧球菌屬)和 Pseudomonas(假單胞菌屬)在精索靜脈曲張患者精液中含量明顯升高,可能與炎癥因素相關(guān)。精索靜脈曲張術(shù)后患者的微生態(tài)有向正常人群變化的趨勢(shì)。結(jié)論:顯微鏡精索靜脈結(jié)扎術(shù)能夠顯著提升術(shù)前精液異常患者的精液質(zhì)量。術(shù)后3月與術(shù)后6月精液參數(shù)未見(jiàn)明顯異常,仍需要更長(zhǎng)時(shí)間隨訪及更大的樣本量來(lái)驗(yàn)證。術(shù)前精液質(zhì)量異常的患者手術(shù)治療效果更佳。精索靜脈曲張患者精液微生態(tài)存在明顯改變,這可能是一種導(dǎo)致精索靜脈曲張患者精液質(zhì)量下降的新機(jī)制。
[Abstract]:Aim: to investigate the effect of microsurgical ligation of spermatic vein on semen parameters of patients with varicocele and the effect of varicocele on sperm microecology. Methods: from March 2015 to December 2016, 90 patients with varicocele diagnosed as varicocele in the first affiliated Hospital of Medical College of Zhejiang University were enrolled in the clinical efficacy study, and 31 of them were included in microecological study. Twenty-four normal male volunteers were enrolled in the control group. All personnel performed semen, blood tests and collected samples. All patients with varicocele were examined by semen examination and semen samples were collected at 3 months and 6 months after operation. The microbial colonies were observed by sequencing the V3-4 region of 16s rRNA. Results: the sperm motility, sperm concentration and sperm count were significantly increased in 90 patients with varicocele 3 months after operation (30.12 鹵17.34%VS 45.68 鹵21.21%, p0.0001, respectively). 23.92 鹵13.96%VS 37.3636 鹵19.33%, p0.0001 脳 41.56 鹵40.06 million / ml VS 56.49 鹵60.22 million / ml,p=0.03; 148.54 鹵157.96 million VS 221.82 鹵241.66 million, p < 0.005), and also increased significantly 6 months after operation (30.12 鹵17.34%VS 43.40,23.92 鹵13.96%VS 36.07 鹵14.37%, p = 0.0005, respectively) compared with that before the operation (30.12 鹵17.34%VS 43.40,23.92 鹵13.96%VS 36.07 鹵14.37%, p = 0.0005, respectively). 41.56 鹵40.06 million / ml VS 49.84 鹵26.82 million / ml,p=0.008;148.54 鹵157.96 million VS 216.99 鹵155.89 million, p = 0.02), but there were no significant changes in semen parameters 3 months after operation and 6 months after operation. There was no significant difference in semen parameters between pre-operation and 3 months after operation in the group of normal semen parameters before operation. In the abnormal semen group, semen parameters, sperm motility, sperm concentration and sperm count were significantly increased (20.53 鹵9.55%VS 42.46 鹵21.23%, p0.0001, respectively). 16.24 鹵7.37%VS 34.21 鹵19.53%, p0.0001 鹵24.32 million / ml VS 44.4鹵 28.02 million / ml,p=0.002;119.59 鹵118.69 million VS201.98 鹵154.2 million, p < 0.001). In microecological study, the abundance of species diversity in patients with varicocele was significantly higher than that in normal men, and the contents of Bacteroidetes and Firmicutes in semen were higher than those in normal men. Proteobaceria (Proteus) (p0.05) was lower, Clostridiales (Clostridiales) (Clostridiales,), Pseudomonadales (,), Corynebactriales (, Corydae), The levels of Anaerococcus (anaerobic cocci) and Pseudomonas (Pseudomonas) in semen of patients with varicocele increased significantly, which may be related to inflammatory factors. The microecology of patients with varicocele after varicocele has a tendency to change to the normal population. Conclusion: microsurgical ligation of spermatic vein can significantly improve the semen quality of patients with abnormal semen before operation. After 3 months and 6 months after operation, there was no significant abnormality in semen parameters, which still required longer follow-up and larger sample size to verify. Surgical treatment of patients with abnormal semen quality before operation is better. There are obvious changes in sperm microecology in patients with varicocele, which may be a new mechanism leading to the decline of semen quality in patients with varicocele.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.8
，
本文編號(hào)：2444184
[Abstract]:Aim: to investigate the effect of microsurgical ligation of spermatic vein on semen parameters of patients with varicocele and the effect of varicocele on sperm microecology. Methods: from March 2015 to December 2016, 90 patients with varicocele diagnosed as varicocele in the first affiliated Hospital of Medical College of Zhejiang University were enrolled in the clinical efficacy study, and 31 of them were included in microecological study. Twenty-four normal male volunteers were enrolled in the control group. All personnel performed semen, blood tests and collected samples. All patients with varicocele were examined by semen examination and semen samples were collected at 3 months and 6 months after operation. The microbial colonies were observed by sequencing the V3-4 region of 16s rRNA. Results: the sperm motility, sperm concentration and sperm count were significantly increased in 90 patients with varicocele 3 months after operation (30.12 鹵17.34%VS 45.68 鹵21.21%, p0.0001, respectively). 23.92 鹵13.96%VS 37.3636 鹵19.33%, p0.0001 脳 41.56 鹵40.06 million / ml VS 56.49 鹵60.22 million / ml,p=0.03; 148.54 鹵157.96 million VS 221.82 鹵241.66 million, p < 0.005), and also increased significantly 6 months after operation (30.12 鹵17.34%VS 43.40,23.92 鹵13.96%VS 36.07 鹵14.37%, p = 0.0005, respectively) compared with that before the operation (30.12 鹵17.34%VS 43.40,23.92 鹵13.96%VS 36.07 鹵14.37%, p = 0.0005, respectively). 41.56 鹵40.06 million / ml VS 49.84 鹵26.82 million / ml,p=0.008;148.54 鹵157.96 million VS 216.99 鹵155.89 million, p = 0.02), but there were no significant changes in semen parameters 3 months after operation and 6 months after operation. There was no significant difference in semen parameters between pre-operation and 3 months after operation in the group of normal semen parameters before operation. In the abnormal semen group, semen parameters, sperm motility, sperm concentration and sperm count were significantly increased (20.53 鹵9.55%VS 42.46 鹵21.23%, p0.0001, respectively). 16.24 鹵7.37%VS 34.21 鹵19.53%, p0.0001 鹵24.32 million / ml VS 44.4鹵 28.02 million / ml,p=0.002;119.59 鹵118.69 million VS201.98 鹵154.2 million, p < 0.001). In microecological study, the abundance of species diversity in patients with varicocele was significantly higher than that in normal men, and the contents of Bacteroidetes and Firmicutes in semen were higher than those in normal men. Proteobaceria (Proteus) (p0.05) was lower, Clostridiales (Clostridiales) (Clostridiales,), Pseudomonadales (,), Corynebactriales (, Corydae), The levels of Anaerococcus (anaerobic cocci) and Pseudomonas (Pseudomonas) in semen of patients with varicocele increased significantly, which may be related to inflammatory factors. The microecology of patients with varicocele after varicocele has a tendency to change to the normal population. Conclusion: microsurgical ligation of spermatic vein can significantly improve the semen quality of patients with abnormal semen before operation. After 3 months and 6 months after operation, there was no significant abnormality in semen parameters, which still required longer follow-up and larger sample size to verify. Surgical treatment of patients with abnormal semen quality before operation is better. There are obvious changes in sperm microecology in patients with varicocele, which may be a new mechanism leading to the decline of semen quality in patients with varicocele.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.8
，
本文編號(hào)：2444184
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