编者按 指南是领域内权威专家的专业经验与实证医学研究文献而制订,仅供专业泌尿外科医生诊疗“参考”;并非法律术语的“医疗常规”或“医疗水准”,也不是法律诉讼的“医疗过失”判断标准。 精索静脉曲张与下列男性疾病具有相关性
不孕症的男性如果进行精索静脉曲张的评估,建议包含
分类 以下为实用临床分类:
诊断方法 基本治疗策略评估 精索静脉曲张与不孕 尝试生育的成年男性如果以下四项皆符合则需接受治疗
治疗方法 1、硬化剂注射治疗或是血管栓塞治疗:须辅以X光静脉造影剂注射进行。 2、手术治疗 精索静脉截断手术 精索静脉曲张手术与非阻塞性无精症 在2017年的META分析中可看到,患者在进行精索静脉曲张手术后,血液中雄性激素的浓度可上升34.3ng/dL(p<0.00001)。 表1 各种治疗方式的复发率及并发症
参考资料:(上下滑动阅读) 1.Freeman,S.,et al.Ultrasound evaluation of varicoceles:guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification,and grading.Eur Radiol 2019. 2.Damsgaard,J.,et al.Varicocele Is Associated with Impaired Semen Quality and Reproductive Hormone Levels:A Study of 7035 Healthy Young Men from Six European Countries.Eur Urol,2016.70:1019. 3.Jensen,C.F.S, et al.Varicocele and male infertility.Nat Rev Urol,2017.14:523 4.Agarwal,A.,et al.Efficacy of varicocelectomy in improving semen parameters:new meta-analytical approach.Urology,2007.70:532 5.Zini,A..et al.Are varicoceles associated with increased deoxyribonucleic acid fragmentation?Fertil Steril,2011.96:1283. 6.Gargollo PC,Diamond DA.Current management of the adolescent varicocele.Curr Urol Rep.2009 Mar;10(2):144-52.Review. 7.Kim,K.H.,et al.Impact of surgical varicocele repain on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality:a meta-analysis of randomized clinical trials. Korean J Urol,2013.54:703. 8.Asafu-Adjei,D.,et al.Systematic Review of the Impact of Varicocele Grade on Response to Surgical Management.J Urol,2020.203:48 9.Yamamoto,M.,et al.Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele:a randomized prospective controlled study.J Urol,1996.155:1636 10.Kroese,A.C.,et al.Surgery or embolization for varicoceles in subfertile men.Cochrane Database Syst Rev,2012.10:CD000479. 11.Silay,M.s.,et al.Treatment of Varicocele in Children and Adolescents:A Systematic Review and Meta-analysis from the European Association of Urology/European Society for Paediatric Urology Guidelines Panel.Eur Urol,2019.75:448. 12.Sajadi,H.,et al.Varicocelectomy May Improve Results for Sperm Retrieval and Pregnancy Rate in Non-Obstructive Azoospermic Men.Int J Fertil Steril,2019.12:303. 13.Esteves,S.C.,et al.Outcome of varicocele repair in men with nonobstructive azoospermia:Systematic review and meta-analysis.Asian J Androl, 2016.18:246. 编辑:蔡宇婷 审核:王欣
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