不同中医证型精索静脉曲张性不育症中西医治疗选择初探

倪凯，陈斌，李鹤等.不同中医证型精索静脉曲张性不育症中西医治疗选择初探[J].中国中西医结合杂志.2013, 33(3):326-331.

精索静脉曲张;中医辨证;男性不育;治疗选择

倪凯，陈斌，李鹤，王鸿祥，杨昊，胡凯，韩银发，王益鑫，黄翼然

上海交通大学医学院附属仁济医院泌尿外科上海市男科学研究所 上海200001 ;上海交通大学医学院附属

2013年

326-331

知网,万方

目的 比较不同中医证型精索静脉曲张(varicocele,VC)伴少、弱精症男性不育患者中西医治疗的疗效,探讨其最佳治疗选择.方法 选择120例VC伴少、弱精症男性不育患者,根据中医辨证分为湿热瘀阻中医治疗组(A组)、湿热瘀阻手术组(B组)、肾虚血瘀中医治疗组(C组)、肾虚血瘀手术组(D组)、血瘀络阻中医治疗组(E组)和血瘀络阻手术组(F组),每组20例.A、C、E组分别给予相应中药治疗,B、D、F组给予精索内静脉显微结扎术治疗,并于治疗前和治疗第24周末进行精液常规分析、精浆生化检查和血清性激素5项(泌乳素、睾酮、卵泡刺激素、黄体生成素及雌二醇)测定.结果 共有18例患者配偶怀孕,其中A组1例,B组3例,C组4例,D组5例,E组1例,F组4例.治疗24周后,B、C、D、F组患者精子浓度、a级精子比例、a+b级精子比例、精子活率以及精浆果糖密度和精浆α-中性糖苷酶均较本组治疗前明显提高(P ＜0.01,P ＜0.05)；A、E组上述指标治疗前后比较,差异均无统计学意义(P＞0.05).相同中医证型组间治疗前后精液常规指标提高百分率以及精浆果糖密度和精浆α-中性糖苷酶差值比较,B组显著优于A组(P＜0.01),F组显著优于E组(P＜0.01),C、D组比较,差异无统计学意义(P ＞0.05).各组患者治疗前后性激素5项比较,差异均无统计学意义(P＞0.05).结论 手术治疗可有效改善VC伴少、弱精症男性不育患者精液质量,其中肾虚血瘀证患者不愿手术治疗可推荐选择中医辨证治疗. Objective To explore the optimal treatment selection for treating varicocele(VC) male infertility patients accompanied with oligozoospermia or azoospermia of different Chinese medical syndrome types by comparing the efficacies of integrative medicine. Methods One hundred and twenty male infertility patients with VC accompanied with oligozoospermia or azoospermia were assigned to Chi- nese medical treatment group(A)and the surgical group旧)，each consisting of three Chinese medical syndrome types，i.e.，damp一heat stagnation syndrome(DHSS)，Shen-deficiency blood stasis syndrome (SDBSS)，and blood stasis stagnation syndrome(BSSS)，20 in each group. Corresponding Chinese medical treatment was administered to those in Group A，C，and E，while microscopic ligation of internal vena spermatica was administered to those in Group B，D，and F. The routine analysis of semen，bio- chemical analysis of seminal plasma，and serum sex hormones(prolactin，testosterone，follicle stimula- ting hormone，luteinizing hormone，and estradiol)were performed before treatment and by the end of the 24th week after treatment. Results Totally 18 patients’spouses were pregnant. Of them，1 in Group A of DHSS(abbreviated as Group A)，3 in Group B of DHSS(abbreviated as Group B)，4 in Group A of SDB-SS(abbreviated as Group C)，5 in Group A of SDBSS(abbreviated as Group D)，1 in Group A of BSSS (abbreviated as Group E)，and 4 in Group B of BSSS(abbreviated as Group F).After 24-week treat- ment，the sperm concentration，class a sperm percentage，class a+b sperm percentage，the motility rate，the seminal plasma of fructose density，and the seminal plasma neutral alpha-glucosidase were more significantly improved in Group B，C，D and F，when compared with the same group before treat- ment (P0. 05).As for the improvement percentage of seminal routine indices，the difference of the seminal plasma of fructose density，and the difference of seminal plasma neutral alpha-glucosidase between before and after treatment in the same Chinese medical syndrome types，better effects were obtained in Group B than in Group A (P0二05).Conclusions Surgical treatment could effectively improve the se- men quality for male infertility VC patients accompanied with oligozoospermia or azoospermia. Of them， Chinese medical treatment could be recommended to those of SDBSS who would not receive surgical treatment.。