标题：显微外科精索静脉低位结扎术对精索静脉曲张患者生育功能及性功能的影响

      作者：李海博，潘锋，张峰磊，潘连军    李海博，潘锋，张峰磊，潘连军南京医科大学附属妇产医院(南京市妇幼保健院)泌尿男科，江苏 南京 210004

      卷次： 2023年34卷24期

      【摘要】 目的 探究显微外科精索静脉低位结扎术对精索静脉曲张患者生育功能及性功能的影响。方法 回顾性分析 2021年9月至2022年 12月在南京市妇幼保健院泌尿男科接受显微外科精索静脉低位结扎手术治疗的65例精索静脉曲张伴有生育功能及性功能下降患者的临床资料，通过精液及血清学检测、睾丸彩超检查、调查问卷等方法，比较患者手术前后的精子浓度及活力、正常精子比例、黄体生成素、血清总睾酮水平、睾丸体积、男性性功能国际勃起功能指数问卷表-5 (IIEF-5)等指标的变化，以评判患者术后生育功能和性功能的改善情况。结果 术后随访 3~6个月，相关指标统计结果显示，与术前比较，患者在精子浓度[(51.99±27.56)×106/mL vs (40.83±24.67)×106/mL]、精子总活力[(40.25±7.74)% vs (28.68±6.29)%]、正常精子比例[(3.83±0.91)% vs (2.65±0.86)%]、黄体生成素[(3.25±0.68) mIU/mL vs (4.57±0.72) mIU/mL]及血清总睾酮水平[(4.29±0.80) ng/mL vs (3.35±0.64) ng/mL]、IIEF-5评分[(18.05±2.10)分 vs (14.70±1.53)分]等均明显改善，差异均具有统计学意义(P<0.05)；而睾丸体积大小在手术前后[(11.44±1.54) mL vs (11.60±1.61) mL]无明显变化，差异无统计学意义(P>0.05)。结论 采取显微外科精索静脉低位结扎术治疗精索静脉曲张，不仅能提高患者的生育功能，也能改善患者血清睾酮水平及性功能。
      【关键词】 精索静脉曲张；显微外科精索静脉低位结扎术；生育功能；性功能
      【中图分类号】 R697+.24 【文献标识码】 A 【文章编号】 1003—6350（2023）24—3618—04

Effect of microsurgical low ligation of spermatic vein on reproductive function and sexual function in patientswith varicocele.
LI Hai-bo, PAN Feng, ZHANG Feng-lei, PAN Lian-jun. Department of Urology and Andrology, Women’sHospital of Nanjing Medical University (Nanjing Maternity and Children's Healthcare Hospital), Nanjing 210004, Jiangsu,CHINA
【Abstract】 Objective To explore the effect of microsurgical low ligation of spermatic vein on reproductivefunction and sexual function in patients with varicocele. Methods The clinical data of 65 patients with varicocele ac-companied by fertility and sexual dysfunction who underwent microsurgical low ligation of spermatic vein in the De-partment of Urology and Andrology, Nanjing Maternity and Children's Healthcare Hospital from September 2021 to De-cember 2022 were retrospectively analyzed. The changes of sperm concentration and motility, normal sperm ratio, lutein-izing hormone, serum total testosterone level, testicular volume, male sexual function International Index of ErectileFunction-5 (IIEF-5) before and after surgery were compared by semen and serological detection, testicular color Dop-pler ultrasound examination, and questionnaire, to evaluate the improvement of postoperative reproductive functionand sexual function. Results The patients were followed up for 3 to 6 months. The statistical results of related indica-tors showed that the sperm concentration [(51.99 ± 27.56) × 106/mL vs (40.83 ±24.67) × 106/mL], total sperm motility[(40.25±7.74)% vs (28.68±6.29)%], normal sperm ratio [(3.83±0.91)% vs (2.65±0.86)%], luteinizing hormone [(3.25±0.68) mIU/mL vs (4.57±0.72) mIU/mL], serum total testosterone level [(4.29±0.80) ng/mL vs (3.35±0.64) ng/mL], andIIEF-5 score [(18.05±2.10) points vs (14.70±1.53) points] were significantly improved compared with those before op-eration (P<0.05). There was no significant change in testicular volume before and after surgery: (11.44±1.54) mL vs(11.60±1.61) mL (P>0.05). Conclusion Microsurgical low ligation of spermatic vein in the treatment of varicocele cannot only improve the reproductive function of patients, but also improve the serum testosterone level and sexual functionof patients.
      【Key words】 Varicocele; Microsurgical low ligation of spermatic vein; Reproductive function; Sexual function