精索静脈瘤の手術適応について

Abstract

1993年～1999年までの精索静脈瘤手術患者148例を対象として, 術後の自然妊娠と関連する術前因子を検討した.術後経過観察期間12～78.2(平均31.1)ヵ月中, 自然妊娠を認めたのは25.7%であった.左側精索静脈瘤のgradeがG0あるいはG1, 術前卵胞刺激ホルモン(FSH)値が20IU/ml以上, 術前精子運動率が0%である場合の術後自然妊娠率は低く, これらの因子を1因子以上満たす群といずれも該当しない群の自然妊娠率はそれぞれ7.7%, 39.8%で後者が有意に高かった.今後は精索静脈瘤全例に手術を行うのではなく, 良い手術適応の症例を選別して治療し, 妊娠への効果の有無を検討する必要がある

The most common and correctable known cause of male infertility is varicoceles, not all infertile patients with varicoceles present an improvement of fertility after surgical repair. In this study, we assessed preoperative factors predictive of improved fertility and/or semen parameters following varicocelectomy. We performed varicocelectomy on 148 consecutive infertile patients with varicocele between 1993 and 1999. Unassisted pregnancy was achieved in 38 (25.7%) patients. The patients with low grade varicocele, high serum follicle stimulating hormone (FSH), severe asthenozoospermia preoperatively had significant lower unassisted pregnancy rates compared to the others, respectively. Patients who have at least one of these three factors had a significantly lower unassisted pregnancy rate compared to patients without all three factors (7.7%, and 39.8%, respectively). In conclusion, certain preoperative variables in the physical and laboratory analyses appeared to predict a greater surgical response.