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目的比较精索静脉曲张显微外科手术与腹膜后高位结扎术对患者术后抗精子抗体(ASA)、精子质量和性激素水平的影响。方法选取本院2013年6月至2015年1月手术治疗的120例精索静脉曲张患者,根据手术方式分为腹膜后精索静脉高位结扎术53例(传统组)和经外环口显微镜下精索静脉结扎术67例(显微手术组),比较两组患者术后ASA阳性率、精子质量和性激素的差异。结果术前显微手术组和传统组患者的精液量、精子浓度、前向运动精子率、精子活动率、精子存活率和ASA阳性率差异均无统计学意义(P>0.05)。术后3个月,显微手术组患者的精子浓度、前向运动精子率、精子活动率、精子存活率均显著的高于传统组(P<0.05);显微手术组患者的ASA阳性率显著低于传统组患者(P<0.05)。术前显微手术组和传统组患者的血清睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)差异均无统计学意义(P>0.05);术后3个月,显微手术组患者的血清睾酮T显著高于传统组患者(P<0.05),而显微手术组患者的FSH、LH水平均显著低于传统组患者(P<0.05)。结论与腹膜后精索静脉高位结扎术相比,显微外科手术患者术后ASA抗体阳性率、精子质量和性激素水平改善较更为明显。
Objective To compare the effects of varicocele microsurgery and retroperitoneal ligation on postoperative anti-sperm antibody (ASA), sperm quality and sex hormone levels. Methods A total of 120 patients with varicocele undergoing surgery from June 2013 to January 2015 were selected and divided into retroperitoneal varicocele ligation (conventional group) and external revascularization 67 cases of varicocele ligation (microsurgical group), ASA-positive rate, sperm quality and sex hormone differences between the two groups were compared. Results There was no significant difference in sperm volume, sperm concentration, motile sperm motility, sperm motility, sperm survival rate and ASA positive rate between preoperative microsurgery group and traditional group (P> 0.05). At 3 months after operation, the sperm concentration, motile sperm motility, sperm motility and sperm survival rate in the microsurgical group were significantly higher than those in the conventional group (P <0.05). The positive rate of ASA in the microsurgical group Significantly lower than the traditional group (P <0.05). There were no significant differences in serum testosterone (T), follicle stimulating hormone (FSH) and luteinizing hormone (LH) between preoperative microsurgery group and traditional group (P> 0.05). At 3 months after operation, Serum testosterone T was significantly higher in the surgery group than in the conventional group (P <0.05), while the levels of FSH and LH in the microsurgery group were significantly lower than those in the conventional group (P <0.05). Conclusion Compared with high ligation of retroperitoneal varicocele, postoperative ASA antibody positive rate, sperm quality and sex hormone level in patients undergoing microsurgery are more obvious.