腹膜后显微镜精索静脉结扎术后精子DNA碎片率变化

摘要

目的 分析腹膜后显微镜精索静脉结扎手术前后患者精子DNA碎片率的变化.方法 2015年07月01日至2017年03月10日在南方医科大学附属佛山市妇幼保健院辅助生殖技术中心男科诊断精索静脉曲张而行腹膜后显微镜左侧精索静脉结扎术的642例患者中,术前术后精液参数、精子DNA碎片率等各项检查指标均完善者共185例,统计分析该部分患者手术前后的精子DNA碎片率、精液量、精子浓度、精子总数、前向运动精子百分率(PR)、精子畸形率等.结果 185例患者术前精子 DNA 碎片指数(DFI) [(22.2 ± 11.5)%]高于术后[(18.4 ± 9.9)%, P<0.001],术前精子高染性指数(HDS)[(11.8 ± 5.4)%]高于术后[(10.9 ± 5.6)%, P<0.001],术前精子浓度为(52.3 ± 44.8)×106/ml显著低于术后精子浓度为(73.5 ± 44.8)×106/ml(P<0.001),术前精子总数[(135.1 ± 115.4)×106]显著低于术后精子总数[(183.2 ± 129.3)×106, P<0.001],术前前向运动精子百分率(PR)[(30.4 ± 16.6)%]显著低于术后[(44.1 ± 16.9)%, P<0.001],术前精子畸形率[(98.1 ± 1.4)%]高于术后[(97.6 ± 1.5)%, P<0.001].术前精液量[(3.7 ± 1.5)ml]与术后精液量[(3.9 ± 3.4)ml]相比差异无统计学意义(P>0.001).结论 精索静脉曲张可能与精子DNA碎片率升高相关,腹膜后显微镜精索静脉结扎术有助于降低精子DNA碎片率,改善精液质量参数.%Objective To analyze the changes of sperm DNA fragmentation rate after retroper-itoneal micro-varicocelectomy(RMV).Methods Totally,642 patients underwent left retroperito-neal micro-varicocelectomy in Assisted Reproductive Technology Center of Foshan Maternal and Child Health Hospital during July 1,2015 to March 10,2017. Among them,185 patients had com-plete examination results such as preoperative and postoperative semen parameters,sperm DNA frag-mentation rate and other indicators.The sperm DNA fragmentation rate,semen volume, total sperm count,percentage of forward spermatozoa(PR)and sperm deformity rate were statistically ana-lyzed.Results The preoperative sperm DNA fragmentation index(DFI)[(22.2 ± 11.5)%] was significantly higher than postoperative DFI[(18.4 ± 9.9)%, P <0.001]in 185 pa-tients.The preoperative high DNA stainability(HDS)[(11.8 ± 5.4)%]was higher than that af-ter operation[(10.9 ± 5.6)%,P<0.001].The total number of spermatozoa was significantly de-creased after the operation[(135.1 ± 115.4)×106 vs.(183.2 ± 129.3)×106, P<0.001] .The percentage of preoperative motorized spermatozoa(PR)(30.4 ± 16.6)% was significantly lower than postoperative RR[(44.1 ± 16.9)%, P<0.001].Preoperative sperm deformity rate (98.1 ± 1.4)% was higher than postoperative sperm deformity rate[(97.6 ± 1.5)%,P<0.001] .Preoperative semen volume[(3.7 ± 1.5)ml]was not significantly different as compared with the postoperative semen volume[(3.9 ± 3.4)mL,P>0.001].Conclusion Varicocele is related to the increase of sperm DNA fragmentation rate.Retroperitoneal micro-varicocelectomy can reduce sperm DNA fragmentation rate and improve semen quality.