精索静脈瘤を伴う乏精子症患者の治療の検討

Abstract

精索静脈瘤を伴う乏精子症患者に対する内精静脈高位結紮術の有効率は34.8%, 妊娠率は20.5%で, 一方kallikrein療法の有効率は30.0%, 妊娠率は25.0%と両者ともほぼ同等であった.また末梢血黄体刺戟ホルモン(LH), あるいは卵胞刺戟ホルモン(FSH)が高値を示した症例には, いずれの治療もほとんど無効であった.kallikrein療法は精索静脈瘤を伴う乏精子症患者の初回治療として有用であり, 高位結紮術の前に施行する.LH, FSHの両者が正常な症例を主たる対象とするべきである

The management of oligospermic patients with varicocele was reviewed. Varicocelectomy was performed in 46 oligospermic patients with varicocele (group 1) and kallikrein treatment was followed for those who failed to improve the semen quality after varicocelectomy (group 2). Twenty oligospermic patients with varicocele were given kallikrein for over 6 months as an initial treatment (group 3). A significant increase in total motile sperm count was noted in 34.8% of the patients in group 1, 22.7% in group 2, and 30.0% in group 3 respectively. Conception rate which was calculated after excluding couples, in which the partner received either artificial insemination by husband or any gynecological treatment, was 20.8% in group 1, 15.4% in group 2, 25.0% in group 3 respectively. No significant changes in hormonal data was observed after either treatment, but semen quality was not improved in patients who showed high serum level of luteinizing hormone (LH) or follicle stimulating hormone (FSH). Kallikrein is useful for oligospermic patients with varicocele as an initial treatment and for those in whom semen quality was not improved after varicocelectomy. Varicocelectomy and/or kallikrein treatment can be recommended mainly for those who show normal serum level of LH and FSH.