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1、手术治疗原发性精索静脉曲张 效果及方式评价 吴小候 重庆医科大学附属第一医院泌尿外科,定义及分类 精索静脉曲张是指精索内蔓状静脉丛的异常伸长、扩张和迂曲。临床上可分为：原发性精索静脉曲张、亚临床型精索静脉曲张、继发性精索静脉曲张三类。,流行病学 约占成年男性人群的1015， 精液异常男性人群发病率25%， 不育症男性人群发病率40%。,病理生理改变 静脉压力升高导致睾丸灌注不足 阴囊局部温度升高 肾源性毒性物质返流 局部代谢物质聚集,临床表现及危害 睾丸生长发育停滞 阴囊及会阴部疼痛或不适 精液质量下降及男性不育 睾丸Leydig细胞功能衰退,精索静脉曲张的治疗方式 观察随访 药物治疗 介入栓
2、塞治疗 手术治疗,手术治疗精索静脉曲张的效果评价,22 prospective studies，The random effect model was used (heterogeneity 2=1210.92 df=21; p 0.0001),percent sperm motility in 17 studies，The random effect model was used (heterogeneity 2=4308.19 df=16; p 0.0001),progressive sperm motility in five studies ，The random effect mod
3、el was used (heterogeneity 2=16.23 df=4; p=0.003),an increase in antioxidant capacity ,a decrease in oxidative stress, A reduction in sperm DNA oxidative damage,a significant improvement in postoperative semenparameters and DFI,精索静脉曲张的手术治疗方式 经腹股沟精索静脉高位结扎术 经腹膜后精索静脉高位结扎术 腹腔镜下精索静脉高位结扎术 显微镜下精索静脉结扎术,传统的开
4、放手术 经腹股沟精索静脉高位结扎术 经腹膜后精索静脉高位结扎术,腹腔镜下精索静脉高位结扎术,显微镜下精索静脉结扎术,常用手术方式的效果评价,Postoperative spontaneous pregnancy rates among different techniques,Postoperative recurrence and hydrocele formation rates among different techniques,In conclusion, Open microsurgical inguinal or subinguinal varicocelectomy techniques have been shown to result in higher spontaneous pregnancy rates and fewer recurrences and postoperative complications than conventional varicocelectomy techniques in infertile men.,谢 谢,