精索静脉曲张诊断与治疗中国专家共识-邓春华-商学军

NJANationalJournalofAndrologyZhonghuaNanKeXueZaZhi201521111035－1042http//．androl．cnAcademicInformation··《》【】Ｒ697+．24Adoi10．13263/j．cnki．nja．2015．11．016varicoceleVC、。。1、。77%～92%10%7%～22%1%1。＞1810～18。。、。210%～15%30%～40%69%～81%1-225．4%3。21．1%36．2%4。9%～26%5。6～1910．76%6。3①5cm5%～10%②③。①。②。③。①②“”③40%23%7-8。、、、、、9。44．1、、·5301·。①②③④⑤⑥NO⑦、、DNA、、10-13。。14-16。4．22%～10%17-18。、nocire-ceptor19-22。4．32324。17-1825-2728-29。55．15．1．1medicalhistory、。。VAS。5．1．2physicalexamination。ValsalvaValsalva、。。。、。、、、。、。。5．1．3imagingexamination5．1．3．1colordopplerultra-sonography30。、、、Valsalva。31①、。②DＲValsalvaDV。③ValsalvaTＲ。3233。④、。⑤、、。CDFI311①DＲ≥1．8mm。②Valsalva≥1。2312mmValsalva。5．1．3．2CT、MＲI·6301·2015112111NatlJAndrolVol．21No．11November2015。5．1．3．3。5．25．2．1①ⅠValsalva。②Ⅱ。③Ⅲ、。5．2．2CDFICDFI343。①DＲ1．8～2．1mmValsalvaTＲ1～2s。②ⅠDＲ2．2～2．7mmValsalvaTＲ2～4s。③ⅡDＲ2．8～3．1mmValsalvaTＲ4～6s。④ⅢDＲ≥3．1mmValsalvaTＲ≥6s。。。5．2．3335①5cm②4～5③。5．35．3．1、、Prader3637。38ml=mm×mm×mm×0．7120mlPrader30～35ml39。。AI＞15%=－/×100%。5．3．23、、pH、、、40。DNA、、α-。5．3．327。5．3．4FSH、LH、PＲL、E41B4243FSHFSH44。FSH、LH45。BFSH46。5．3．5。5．4、。、、、。。6、、。、。。6．1、。47-49、、。50·7301·2015112111NatlJAndrolVol．21No．11November201551。6．26．2．1①52、、、53-55。、56。57-59。②260、61-62。6364。6．2．2、、。65-67。6．2．3、。6．36．3．16．3．1．11368-71①②③。1～2。72-74。26971。3、196875-80。4ⅡⅢ。6．3．1．269-7081-82。6．3．1．3384569-7083-88①ⅡⅢ②20%③④⑤。。、。6．3．2、、。。、、。、、。6．3．3、、。6．3．3．13%～39%7%。6．3．3．20．2%。6．3．3．3、。0．6%～45%89。6．3．3．4、。6．3．4·8301·2015112111NatlJAndrolVol．21No．11November2015。“”89。690-9192。、、、/、、89-9093-94。6．3．550%～94%95-97。、96。97。、98-101DNA102。60%～76%10311．8%～20%31．8%～36．2%104-107。6．4。、。、、B、、6971108。①1～21。1697188108。②3～62～43～6、。③1～23311。④、69-71108-111。1KurshED．Whatistheincidenceofvaricoceleinafertilepopula-tionFertilSteril1987483510-511．2SabaneghEAA．Maleinfertility．InWeinAJKLNovickACeditor．10thed．Campbell-Walshurology．PhiladelphiaSaun-ders2012．636-637．3WorldHealthOrganization．Theinfluenceofvaricoceleonparame-tersoffertilityinalargegroupofmenpresentingtoinfertilityclin-ics．FertilSteril19925761289-1293．4GokceADavarciMYalcinkayaFＲetal．Hereditarybehaviorofvaricocele．JAndrol2010313288-290．5ZampieriNCervellioneＲM．VaricoceleinadolescentsA6-yearlongitudinalandfollowupobservationalstudy．JUrol20081804Suppl1653-1656．6．．2005263132-134．7AhlbergNEBartleyOChidekelN．Ｒightandleftgonadalveins．Ananatomicalandstatisticalstudy．ActaＲadiol196646593-601．8PastuszakAWWangＲ．Varicoceleandtesticularfunction．Asi-anJAndrol2015174659-667．9SignoriGBMartinoFMonticelliLetal．Secondaryvaricoceleasaclinicalmanifestationofprimitiveretroperitonealtumor．Mi-nervaUrologicaEenefrologica1998504267-269．10AgarwalAHamadaAEstevesSC．Insightintooxidativestressinvaricocele-associatedmaleinfertilityPart1．NatＲevUrol2012912678-690．11HamadaAEstevesSCAgarwalA．Insightintooxidativestressinvaricocele-associatedmaleinfertilityPart2．NatＲevUrol201310126-37．12SheehanMMＲamasamyＲLambDJ．Molecularmechanismsinvolvedinvaricocele-associatedinfertility．JAssistedＲeprodGenet2014315521-526．·9301·2015112111NatlJAndrolVol．21No．11November201513WangHSunYWangLetal．Hypoxia-inducedapoptosisinthebilateraltestesofratswithleft-sidedvaricoceleAnewwaytothinkaboutthevaricocele．JAndrol2010313299-305．14．、．2006122154-155．15．α-14-、．2006127619-621．16Vivas-AcevedoGLozano-HernandezＲCamejoMI．Varicoceledecreasesepididymalneutralalpha-glucosidaseandisassociatedwithalterationofnuclearDNAandplasmamembraneinsperma-tozoa．BJUInt20141134642-649．17CayanSKadiogluAOrhanIetal．Theeffectofmicrosurgicalvaricocelectomyonserumfolliclestimulatinghormonetestoste-roneandfreetestosteronelevelsininfertilemenwithvaricocele．BJUInter19998491046-1049．18HsiaoWＲosoffJSPaleJＲetal．Olderageisassociatedwithsimilarimprovementsinsemenparametersandtestosteroneaftersubinguinalmicrosurgicalvaricocelectomy．JUrol20111852620-625．19PetersonACLanceＲSＲuizHE．Outcomesofvaricoceleliga-tiondoneforpain．JUrol199815951565-1567．20AbdEllatifMEAskerWAbbasAetal．VaricocelectomytotreatpainandpredictorsofsuccessAprospectivestudy．CurrUrol20126133-36．21LvKLZhuangJTZhaoLetal．VaricoceleanatomyduringsubinguinalmicrosurgicalvaricocelectomyinChinesemen．An-drologia2015．22．．2013364409-410．23ChenSSHuangWJ．Differencesinbiochemicalmarkersandbodymassindexbetweenpatientswithandwithoutvaricocele．JChinMedAssoc2010734194-198．24Al-AliBMMarszalekMShamloulＲetal．Clinicalparame-tersandsemenanalysisin716Austrianpatientswithvaricocele．Urology20107551069-1073．25TanrikutCMcQuaidJWGoldsteinM．Theimpactofvaricoceleandvaricocelerepaironserumtestosterone．CurrOpinObstetGynecol2011234227-231．26GatYGornishMBelenkyAetal．Elevationofserumtestos-teroneandfreetestosteroneafterembolizationoftheinternalsper-maticveinforthetreatmentofvaricoceleininfertilemen．HumＲeprod200419102303-2306．27TanrikutCGoldsteinMＲosoffJSetal．Varicoceleasariskfactorforandrogendeficiencyandeffectofrepair．BJUInter201110891480-1484．28ＲodriguezPenaMAlescioLＲussellAetal．Predictorsofimprovedseminalparametersandfertilityaftervaricocelerepairinyoungadults．Andrologia2009415277-281．29ZhengYQGaoXLiZJetal．Efficacyofbilateralandleftvaricocelectomyininfertilemenwithleftclinical