精索静脉高位结扎术联合调肝活血汤治疗少、弱精子症的效果观察(1)
[摘要]目的 观察经验方调肝活血汤联合Palomo术对精索静脉曲张引起的男性不育症的疗效。方法 选取2014年5月～2015年8月我院99名精索静脉曲张症相关不育患者，随机将其分成三组，每组33例患者。试验组(G1)采用调肝活血汤联合Palomo手术治疗，中药对照组(G2)单独采用调肝活血汤口服，手术对照组(G3)采用Palomo手术治疗，药物治疗6个月。观察治疗前后精液质量的变化。结果 试验组精液质量改善明显，精子畸形率降低[G1：(35.35±8.25)%、G2：(52.22±9.49)%、G3：(51.52±7.44)%]，有效率明显提高(G1：90.9%、G2：72.8%、G3：69.7%)，差异有统计学意义(P<0.05)。结论 调肝活血汤联合Palomo术治疗精索静脉曲张相关少、弱精子症具有良好的效果。
[关键词] 调肝活血汤；Palomo手术；精索静脉曲张症；少、弱精子症
[中图分类号] R698.2 [文献标识码] A [文章编号] 1674-4721(2016)07(b)-0141-05
[Abstract]Objective To observe the effect of proved prescription regulating liver and removing blood stasis decoction combined with Palomo operation on male infertility due to varicocele.Methods 99 patients with male infertility due to varicocele in our hospital from May 2014 to August 2015 were selected and divided into three groups.Patients in study group (G1) were treated by regulating liver and removing blood stasis decoction combined with Palomo operation，patients in TCM control group (G2) were only given regulating liver and removing blood stasis decoction，and patients in operation control group (G3) were treated by Palomo operation.The changes of sperm quality were observed after 6 months of treatment.Results The sperm quality in study group was improved，and rate of sperm deformation was reduced[G1：(35.35±8.25)%，G2：(52.22±9.49)%，G3：(51.52±7.44)%]，efficient had improved significantly (G1：90.9%，G2：72.8%，G3：69.7%)，which was significantly superior to those in the other two groups (P<0.05).Conclusion Regulating liver and removing blood stasis decoction combined with Palomo operation has favorable effect in treatment of oligospermia and asthenospermia related to varicocele.
[Key words] Regulating liver and removing blood stasis decoction；Palomo operation；Varicocele；Oligospermia and asthenospermia
男性不育症指的是育龄夫妻婚后同居一年以上，未采用任何避孕措施由于男性方面的原因造成女方不孕者[1]。不育症临床表现包括性欲下降、勃起功能障碍、射精障碍、精液稀少等，其中少精子、弱精子以及精子形态缺陷是最重要的因素。引起男性不育的成因众多，既有先天性因素又有后天疾病因素，其中精索静脉曲张症是临床常见的一种病因。笔者应用中西医结合方式治疗精索静脉曲张症相关的男性不育症取得较好的效果，现报道如下。
1资料与方法
1.1一般资料
1.1.1病例选择
选取2014年5月～2015年8月在我院男科门诊就诊的不育症患者99例，男性，年龄28～45岁，平均年龄33岁；病程1～5年，平均2年8个月。
1.1.2西医诊断标准
1.1.2.1精索静脉曲张分度标准 按照曲张程度由轻到重划为4个等级。①亚临床型；体格检查为阴性，超声在平静呼吸状态下探及精索静脉内无反流，做Valsalva动作时有反流，DR：1.8～2.1 mm，TR：1～2 s。②精索静脉曲张Ⅰ级：体检触诊为阳性，做Valsalva动作时有反流，平静呼吸时DR：2.2～2.7 mm，TR：3～4 s。③精索静脉曲张Ⅱ级：体检触诊为阳性，做Valsalva动作时有反流，DR：2.8～3.1 mm，TR：5～6 s。④精索静脉曲张症Ⅲ级：触诊呈阳性，做Valsalva动作时反流明显，平静呼吸时DR>3.1 mm，TR>6 s。
1.1.2.2男性不育症标准 参考WHO《人类精液及精子——宫颈黏液相互作用实验检验手册》：育龄夫妻婚后同居1年以上，性生活正常而未采用任何避孕措施由于男性方面的原因造成女方不孕者；精子浓度<15×106/ml为少精子症；前向运动精子比例<32%为弱精子症。 (古宇能 曾杨玲 王全 陈德宁)
[关键词] 调肝活血汤；Palomo手术；精索静脉曲张症；少、弱精子症
[中图分类号] R698.2 [文献标识码] A [文章编号] 1674-4721(2016)07(b)-0141-05
[Abstract]Objective To observe the effect of proved prescription regulating liver and removing blood stasis decoction combined with Palomo operation on male infertility due to varicocele.Methods 99 patients with male infertility due to varicocele in our hospital from May 2014 to August 2015 were selected and divided into three groups.Patients in study group (G1) were treated by regulating liver and removing blood stasis decoction combined with Palomo operation，patients in TCM control group (G2) were only given regulating liver and removing blood stasis decoction，and patients in operation control group (G3) were treated by Palomo operation.The changes of sperm quality were observed after 6 months of treatment.Results The sperm quality in study group was improved，and rate of sperm deformation was reduced[G1：(35.35±8.25)%，G2：(52.22±9.49)%，G3：(51.52±7.44)%]，efficient had improved significantly (G1：90.9%，G2：72.8%，G3：69.7%)，which was significantly superior to those in the other two groups (P<0.05).Conclusion Regulating liver and removing blood stasis decoction combined with Palomo operation has favorable effect in treatment of oligospermia and asthenospermia related to varicocele.
[Key words] Regulating liver and removing blood stasis decoction；Palomo operation；Varicocele；Oligospermia and asthenospermia
男性不育症指的是育龄夫妻婚后同居一年以上，未采用任何避孕措施由于男性方面的原因造成女方不孕者[1]。不育症临床表现包括性欲下降、勃起功能障碍、射精障碍、精液稀少等，其中少精子、弱精子以及精子形态缺陷是最重要的因素。引起男性不育的成因众多，既有先天性因素又有后天疾病因素，其中精索静脉曲张症是临床常见的一种病因。笔者应用中西医结合方式治疗精索静脉曲张症相关的男性不育症取得较好的效果，现报道如下。
1资料与方法
1.1一般资料
1.1.1病例选择
选取2014年5月～2015年8月在我院男科门诊就诊的不育症患者99例，男性，年龄28～45岁，平均年龄33岁；病程1～5年，平均2年8个月。
1.1.2西医诊断标准
1.1.2.1精索静脉曲张分度标准 按照曲张程度由轻到重划为4个等级。①亚临床型；体格检查为阴性，超声在平静呼吸状态下探及精索静脉内无反流，做Valsalva动作时有反流，DR：1.8～2.1 mm，TR：1～2 s。②精索静脉曲张Ⅰ级：体检触诊为阳性，做Valsalva动作时有反流，平静呼吸时DR：2.2～2.7 mm，TR：3～4 s。③精索静脉曲张Ⅱ级：体检触诊为阳性，做Valsalva动作时有反流，DR：2.8～3.1 mm，TR：5～6 s。④精索静脉曲张症Ⅲ级：触诊呈阳性，做Valsalva动作时反流明显，平静呼吸时DR>3.1 mm，TR>6 s。
1.1.2.2男性不育症标准 参考WHO《人类精液及精子——宫颈黏液相互作用实验检验手册》：育龄夫妻婚后同居1年以上，性生活正常而未采用任何避孕措施由于男性方面的原因造成女方不孕者；精子浓度<15×106/ml为少精子症；前向运动精子比例<32%为弱精子症。 (古宇能 曾杨玲 王全 陈德宁)