保留动脉Palomo术后人工授精的结局分析
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摘要
目的分析保留动脉Palomo术对夫精宫腔内人工授精(AIH)妊娠结局的影响。方法收集2012年9月至2015年1月在本院辅助生殖中心门诊就诊的60对不孕不育夫妇为研究对象,共127个AIH周期。根据男方是否行保留动脉Palomo术分为手术组及观察组:手术组,29对夫妻(59个周期);观察组,31对夫妻(68个周期)。观察精索静脉曲张患者行保留动脉Palomo术后精液质量变化情况,比较两组患者AIH妊娠结局。结果手术组患者行保留动脉Palomo术后,精子浓度、存活率、前向运动精子百分率均显著高于手术前(P<0.05)。手术组共13对夫妻获得临床妊娠,观察组8对夫妻获得临床妊娠;手术组的周期妊娠率(22.03%vs.11.76%)及累计妊娠率均显著高于观察组(44.83%vs.25.81%)(P<0.05)。结论保留动脉Palomo术可以改善精索静脉曲张患者的精液质量,提高AIH妊娠率。
Objective:To analyze the influence of the outcome of artificial insemination with husband sperm(AIH)after Palomo varicoceletomy with preserving artery.Methods:A total of 127 AIH cycles of 60 infertile couples in our hospital from September 2012 to January 2015 were included in the study.According to whether the male patients underwent Palomo varicoceletomy with preserving artery,they were divided into operation group(29 couples/59 cycles)and observation group(31 couples/68 cycles).The changes of semen quality in patients with varicocele after operation were observed,and the pregnancy outcomes of AIH were compared between the two groups.Results:The sperm concentration,survival rate and percentage of forward motile sperm after operation were significantly higher than those before operation in operation group(P<0.05).Thirteen couples got clinical pregnancy in the operation group,while 8 couples got clinical pregnancy in the observation group.The pregnancy rate per cycle(22.03% vs.11.76%)and cumulative pregnancy rate(44.83% vs.25.81%)in operation group were significantly higher than observation group(P<0.05).Conclusions:The Palomo varicoceletomy with preserving artery can improve semen quality,and increase AIH pregnancy rate in patients with varicocele.
Objective:To analyze the influence of the outcome of artificial insemination with husband sperm(AIH)after Palomo varicoceletomy with preserving artery.Methods:A total of 127 AIH cycles of 60 infertile couples in our hospital from September 2012 to January 2015 were included in the study.According to whether the male patients underwent Palomo varicoceletomy with preserving artery,they were divided into operation group(29 couples/59 cycles)and observation group(31 couples/68 cycles).The changes of semen quality in patients with varicocele after operation were observed,and the pregnancy outcomes of AIH were compared between the two groups.Results:The sperm concentration,survival rate and percentage of forward motile sperm after operation were significantly higher than those before operation in operation group(P<0.05).Thirteen couples got clinical pregnancy in the operation group,while 8 couples got clinical pregnancy in the observation group.The pregnancy rate per cycle(22.03% vs.11.76%)and cumulative pregnancy rate(44.83% vs.25.81%)in operation group were significantly higher than observation group(P<0.05).Conclusions:The Palomo varicoceletomy with preserving artery can improve semen quality,and increase AIH pregnancy rate in patients with varicocele.
引文
[1]邓春华,商学军.精索静脉曲张诊断与治疗中国专家共识[J].中华男科学杂志,2015,21:1035-1042.
[2]黄健,江专新,覃云凌,等.显微精索静脉结扎术治疗精索静脉曲张的疗效评价(附48例报告)[J].中华男科学杂志,2015,21:757-759.
[3]Ozdamar AS,Soylu AG,Culha M,et al.Testicular oxidative stress.Effects of experimental varicocele in adolescent rats[J].Urol Int,2004,73:343-347.
[4]?ayan S,?ahin S,Akbay E.Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only:a single institution experience with 408patients[J].J Urol,2017,198:195-201.
[5]中华医学会编著.临床诊疗指南:辅助生殖技术与精子库分册[M].北京:人民卫生出版社,2009:60-63.
[6]Delaney DP,Carr MC,Kolon TF,et al.The physical characteristics of young males with varicocele[J].BJU Int,2004,94:624-626.
[7]宋景艳,孙振高.精索静脉曲张致睾丸生精功能障碍的机制研究进展[J].生殖医学杂志,2016,25:186-189.
[8]Zhang K,Wang Z,Wang H,et al.Hypoxia-induced apoptosis and mechanism of epididymal dysfunction in rats with left-side varicocele[J].Andrologia,2016,48:318-324.
[9]Lehtihet M,Arver S,Kalin B,et al.Left-sided grade 3varicocele may affect the biological function of the epididymis[J].Scand J Urol,2014,48:284-289.
[10]中华医学会男科分会主编.中国男科疾病诊断治疗指南与专家共识(2016版)[M].北京:人民卫生出版社,2016:41.
[11]Donkol RH,Salem T.Paternity after varicocelectomy:preoperative sonographic parameters of success[J].JUltrasound Med,2007,26:593-599.
[12]Esteves SC,Miyaoka R,Roque M,et al.Outcome of varicocele repair in men with nonobstructive azoospermia:systematic review and meta-analysis[J].Asian J Androl,2016,18:246-253.
[13]Gat Y,Zukeman Z,Chakraborty J,et al.Varicocele,hypoxia and male infertility.Fluid mechanics analysis of the impaired testicular venous drainage system[J].Hum Reprod,2005,20:2614-2619.
[14]唐运革,唐立新,王奇玲,等.132例不育男性精索静脉曲张患者手术疗效分析[J].中国男科学杂志,2011,25:26-29.
[15]Kim KH,Lee JY,Kang DH,et al.Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality:a meta-analysis of randomized clinical trials[J].Korean J Urol,2013,54:703-709.
[16]彭靖,龙海,袁亦铭,等.显微镜下和腹腔镜下精索静脉结扎术的疗效比较[J].北京大学学报(医学版),2014,46:541-543.
[17]Werthman P,Wixon R,Kasperson K,et al.Significant decrease in sperm deoxyribonucleic acid fragmentation after varicocelectomy[J].Fertil Steril,2008,90:1800-1804.
[18]Haydardedeoglu B,Turunc T,Kilicdag EB,et al.The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes:a retrospective pilot study[J].Urology,2010,75:83-86.
[19]Baker K,McGill J,Sharma R,et al.Pregnancy after varicocelectomy:impact of postoperative motility and DFI[J].Urology,2013,81:760-766.
[2]黄健,江专新,覃云凌,等.显微精索静脉结扎术治疗精索静脉曲张的疗效评价(附48例报告)[J].中华男科学杂志,2015,21:757-759.
[3]Ozdamar AS,Soylu AG,Culha M,et al.Testicular oxidative stress.Effects of experimental varicocele in adolescent rats[J].Urol Int,2004,73:343-347.
[4]?ayan S,?ahin S,Akbay E.Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only:a single institution experience with 408patients[J].J Urol,2017,198:195-201.
[5]中华医学会编著.临床诊疗指南:辅助生殖技术与精子库分册[M].北京:人民卫生出版社,2009:60-63.
[6]Delaney DP,Carr MC,Kolon TF,et al.The physical characteristics of young males with varicocele[J].BJU Int,2004,94:624-626.
[7]宋景艳,孙振高.精索静脉曲张致睾丸生精功能障碍的机制研究进展[J].生殖医学杂志,2016,25:186-189.
[8]Zhang K,Wang Z,Wang H,et al.Hypoxia-induced apoptosis and mechanism of epididymal dysfunction in rats with left-side varicocele[J].Andrologia,2016,48:318-324.
[9]Lehtihet M,Arver S,Kalin B,et al.Left-sided grade 3varicocele may affect the biological function of the epididymis[J].Scand J Urol,2014,48:284-289.
[10]中华医学会男科分会主编.中国男科疾病诊断治疗指南与专家共识(2016版)[M].北京:人民卫生出版社,2016:41.
[11]Donkol RH,Salem T.Paternity after varicocelectomy:preoperative sonographic parameters of success[J].JUltrasound Med,2007,26:593-599.
[12]Esteves SC,Miyaoka R,Roque M,et al.Outcome of varicocele repair in men with nonobstructive azoospermia:systematic review and meta-analysis[J].Asian J Androl,2016,18:246-253.
[13]Gat Y,Zukeman Z,Chakraborty J,et al.Varicocele,hypoxia and male infertility.Fluid mechanics analysis of the impaired testicular venous drainage system[J].Hum Reprod,2005,20:2614-2619.
[14]唐运革,唐立新,王奇玲,等.132例不育男性精索静脉曲张患者手术疗效分析[J].中国男科学杂志,2011,25:26-29.
[15]Kim KH,Lee JY,Kang DH,et al.Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality:a meta-analysis of randomized clinical trials[J].Korean J Urol,2013,54:703-709.
[16]彭靖,龙海,袁亦铭,等.显微镜下和腹腔镜下精索静脉结扎术的疗效比较[J].北京大学学报(医学版),2014,46:541-543.
[17]Werthman P,Wixon R,Kasperson K,et al.Significant decrease in sperm deoxyribonucleic acid fragmentation after varicocelectomy[J].Fertil Steril,2008,90:1800-1804.
[18]Haydardedeoglu B,Turunc T,Kilicdag EB,et al.The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes:a retrospective pilot study[J].Urology,2010,75:83-86.
[19]Baker K,McGill J,Sharma R,et al.Pregnancy after varicocelectomy:impact of postoperative motility and DFI[J].Urology,2013,81:760-766.