The Times
November 29, 2006
Simple surgery can restore male fertility
Mark Henderson
Varicose veins in testicles to blame
Operation can revive sperm count
Graphic: how it works
One of the commonest causes of male infertility can be treated successfully with a simple and minimally invasive surgical procedure that improves significantly the chances of fathering a child.
The new technique can correct knots of varicose veins in the scrotum, known as varicoceles, that can adversely affect a man’s sperm count and quality, research in Germany has shown.
Within six months of 173 previously infertile men with at least one varicocele receiving the therapy, a quarter of their partners had become pregnant, scientists at the University of Bonn found.
The treatment also significantly improved average sperm counts and enhanced sperm motility — a measure of its swimming ability which is critical to fertility.
“We found that spermatic vein embolisation combined with anti-inflammatory treatment improves sperm motility and sperm count in infertile men with varicoceles,” said Sebastian Flacke, who led the study. “Six months after treatment, 26 per cent of couples had achieved a pregnancy.”
Varicoceles are common, affecting up to 20 per cent of adult men. The networks of faulty veins usually develop between the ages of 15 and 25. They are often harmless and lead to no serious symptoms, but can at times cause pain and damage the testis.
As with varicose veins in the legs, varicoceles occur when the one-way valves inside veins that draw blood away from the testicles and back towards the heart fail. This means that blood does not circulate properly out of the testicles, causing swelling and the formation of a clump of tangled blood vessels that can be felt through the scrotum.
The reverse blood flow can both raise pressure on the testis, potentially causing tissue damage and shrinkage, and raise the temperature with adverse effects on sperm quality. About 40 per cent of infertile men have varicoceles, many more than in the general population, though the link to infertility is not universally accepted by specialists.
Traditional treatment has normally involved open surgery to remove the faulty veins, but the new embolisation process now offers a much less invasive alternative.
A small cut is made in the groin area, and a catheter is fed into the affected vein, using x-ray guidance to find the right place. A special fluid and tiny platinum coils are then injected, which cause the blood to clot and close off the faulty vein. Blood then cannot flow back down it towards the testicles, and instead returns towards the heart using healthy veins. The procedure is performed under local anaesthetic, it is not normally painful, and patients can usually leave hospital and even return to work the next day.
In the study, which was presented yesterday at the Radiological Society of North America conference in Chicago, Dr Flacke’s team treated 223 infertile men aged between 18 and 50 for varicoceles, using embolisation. A semen analysis was performed on 173 of them. All the men had healthy, apparently fertile female partners with whom they were trying to conceive. Of the 228 varicoceles treated in this way (some patients had more than one), 226 were cured.
Six months after treatment, 45 of the men’s partners were pregnant. “This study confirms that varicocele repair can significantly improve sperm count and motility,” Dr Flacke said.
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The Times
November 29, 2006
《时代》杂志 2006年11月29日
Simple surgery can restore male fertility
Mark Henderson
题目：简单的手术可恢复男性生育能力
作者：Mark Henderson
Varicose veins in testicles to blame
过失是睾丸的静脉曲张
Operation can revive sperm count
手术可恢复精子数量
Graphic: how it works
One of the commonest causes of male infertility can be treated successfully with a simple and minimally invasive surgical procedure that improves significantly the chances of fathering a child.
图示：它的作用方式
最常见的男性不育原因之一的情况可以成功地通过简单和侵害少的外科手术即可显著增加男性养育后代的机会。
The new technique can correct knots of varicose veins in the scrotum, known as varicoceles, that can adversely affect a man’s sperm count and quality, research in Germany has shown.
德国的研究发现新技术可以纠正影响男人精子数目和质量的精索静脉曲张（即精囊的曲张的静脉结）。
Within six months of 173 previously infertile men with at least one varicocele receiving the therapy, a quarter of their partners had become pregnant, scientists at the University of Bonn found.
波恩大学的科学家发现在173名不育男性在6个月内至少进行一侧精索静脉曲张的治疗，则四分之一的伴侣会怀孕。
The treatment also significantly improved average sperm counts and enhanced sperm motility — a measure of its swimming ability which is critical to fertility.
治疗结果可显著提高平均精子数目和提高精子的运动性-即它的泳动能力（这是不育的关键因素）。
“We found that spermatic vein embolisation combined with anti-inflammatory treatment improves sperm motility and sperm count in infertile men with varicoceles,” said Sebastian Flacke, who led the study. “Six months after treatment, 26 per cent of couples had achieved a pregnancy.”
研究的领导者Sebastian Flacke说，“我们发现精巢静脉栓塞合并抗炎处理可以提高有精索静脉曲张的不育男性的精子的运动性和数目。治疗6个月后有26%的伴侣怀孕。”
Varicoceles are common, affecting up to 20 per cent of adult men. The networks of faulty veins usually develop between the ages of 15 and 25. They are often harmless and lead to no serious symptoms, but can at times cause pain and damage the testis.
精索静脉曲张是常见的疾病，影响到20%以上的成年男性。不完善的静脉网络产生于15-25岁之间，虽然没有常见的严重症状且不影响正常生活，但是有时可使睾丸疼痛和损伤。
As with varicose veins in the legs, varicoceles occur when the one-way valves inside veins that draw blood away from the testicles and back towards the heart fail. This means that blood does not circulate properly out of the testicles, causing swelling and the formation of a clump of tangled blood vessels that can be felt through the scrotum.
如腿部的静脉曲张，精索静脉曲张是由于不能静脉丛将睾丸组织的血液回流至心脏而产生的，也就是睾丸的血流循环不畅导致通过阴囊就可触及的纠结形成的静脉肿块。
The reverse blood flow can both raise pressure on the testis, potentially causing tissue damage and shrinkage, and raise the temperature with adverse effects on sperm quality. About 40 per cent of infertile men have varicoceles, many more than in the general population, though the link to infertility is not universally accepted by specialists.
逆流的血液可使睾丸压力增加，导致组织损伤和收缩，提高温度降低精子的质量。大约40%的不育男性患有精索静脉曲张，比正常人群比例高。它与不育的关系并不被所有专家接受。
Traditional treatment has normally involved open surgery to remove the faulty veins, but the new embolisation process now offers a much less invasive alternative.
传统的治疗方法是去除紊乱血管的开放性手术，但是新方法采用栓塞技术可使手术损伤小。
A small cut is made in the groin area, and a catheter is fed into the affected vein, using x-ray guidance to find the right place. A special fluid and tiny platinum coils are then injected, which cause the blood to clot and close off the faulty vein. Blood then cannot flow back down it towards the testicles, and instead returns towards the heart using healthy veins. The procedure is performed under local anaesthetic, it is not normally painful, and patients can usually leave hospital and even return to work the next day.
首先在腹股沟处开一小口，然后在X-射线的指导下将导管正确放置在受影响血管。将一种特殊的液体和小的铂丝注入血管导致血液凝固和病变血管关闭，于是血液不能回流至睾丸而直接利用健康血管流向心脏。手术在局麻下进行，疼痛少，病人通常可当天离院，甚至第二天可去上班。
In the study, which was presented yesterday at the Radiological Society of North America conference in Chicago, Dr Flacke’s team treated 223 infertile men aged between 18 and 50 for varicoceles, using embolisation. A semen analysis was performed on 173 of them. All the men had healthy, apparently fertile female partners with whom they were trying to conceive. Of the 228 varicoceles treated in this way (some patients had more than one), 226 were cured.
此研究成果是在芝加哥举行的南美放射协会会议上公布的。Flacke博士的研究小组用栓塞方法共治疗了223名18到50岁的不育男性。其中检测了173个人的精子，结果显示他们的精子很健康，这是他们梦寐以求的结果。进行的228次精索静脉曲张(其中有人两侧患病)手术治疗，其中226次成功。
Six months after treatment, 45 of the men’s partners were pregnant. “This study confirms that varicocele repair can significantly improve sperm count and motility,” Dr Flacke said.
六个月治疗后，其中45位男性患者的伴侣怀孕。Flacke博士认为此研究可证明精索静脉曲张修复手术可显著提高不育男性的精子的数目和运动性。
《时代》杂志 2006年11月29日
题目：简单的手术可恢复男性生育能力
作者：Mark Henderson
过失是睾丸的静脉曲张；手术可恢复精子数量
最常见的男性不育原因之一的情况可以成功地通过简单和侵害少的外科手术即可显著增加男性养育后代的机会。德国的研究发现新技术可以纠正影响男人精子数目和质量的精索静脉曲张（即精囊的曲张的静脉结）。
精索静脉曲张是常见的疾病，影响到20%以上的成年男性。不完善的静脉网络产生于15-25岁之间，虽然没有常见的严重症状且不影响正常生活，但是有时可使睾丸疼痛和损伤。就像腿部的静脉曲张，精索静脉曲张是由于不能静脉丛将睾丸组织的血液回流至心脏而产生的，也就是睾丸的血流循环不畅导致通过阴囊就可触及的纠结形成的静脉肿块。逆流的血液可使睾丸压力增加，导致组织损伤和收缩，提高温度降低精子的质量。大约40%的不育男性患有精索静脉曲张，比正常人群比例高。它与不育的关系并不被所有专家接受。传统的治疗方法是去除紊乱血管的开放性手术，但是新方法采用栓塞技术可使手术损伤小。
波恩大学的科学家发现在173名不育男性在6个月内至少进行一侧精索静脉曲张的治疗，则四分之一的伴侣会怀孕。治疗结果可显著提高平均精子数目和提高精子的运动性-即它的泳动能力（这是不育的关键因素）。研究的领导者Sebastian Flacke说，“我们发现精巢静脉栓塞合并抗炎处理可以提高有精索静脉曲张的不育男性的精子的运动性和数目。治疗6个月后有26%的伴侣怀孕。”首先在腹股沟处开一小口，然后在X-射线的指导下将导管正确放置在受影响血管。将一种特殊的液体和小的铂丝注入血管导致血液凝固和病变血管关闭，于是血液不能回流至睾丸而直接利用健康血管流向心脏。手术在局麻下进行，疼痛少，病人通常可当天离院，甚至第二天可去上班。
此研究成果是在芝加哥举行的南美放射协会会议上公布的。Flacke博士的研究小组用栓塞方法共治疗了223名18到50岁的不育男性。其中检测了173个人的精子，结果显示他们的精子很健康，这是他们梦寐以求的结果。进行的228次精索静脉曲张(其中有人两侧患病)手术治疗，其中226次成功。六个月治疗后，其中45位男性患者的伴侣怀孕。Flacke博士认为此研究可证明精索静脉曲张修复手术可显著提高不育男性的精子的数目和运动性。
1. Varicose veins in testicles to blame
过失是睾丸的静脉曲张
试译：手术适应证为睾丸静脉曲张
2. One of the commonest causes of male infertility can be treated successfully with a simple and minimally invasive surgical procedure that improves significantly the chances of fathering a child.
最常见的男性不育原因之一的情况可以成功地通过简单和侵害少的外科手术即可显著增加男性养育后代的机会。
试译：最常见的一种病因引起的男性不育可经简单的最小侵入性手术成功治愈，手后患者的生育能力可显著提高。
3. sperm motility ：精子活动力
这么无知的新闻，这么无聊的手术。VC结扎手术对不育症患者精液质量的提高绝对不是如文章所说的，对临床妊娠率的提高亦不是如此。WHO全球联合的研究报告表明：几个对照研究已经对精索静脉曲张的治疗作了评估。其中2个是单中心研究，样本量足够大，统计学分析可信。在第一个研究中，精索静脉曲张外科治疗后，妊娠率较低，为10%，与未治疗组没有明显差别。第二个研究为前瞻性随机对照研究，外科治疗同夫妇生育咨询效果相近，一年后都有大约30％的妊娠率。
WHO已经组织了一个多中心前瞻性随机研究，在这些不育夫妇中，男方均有适度的少精子症（5～20×106）和Ⅱ度或Ⅲ度的精索静脉曲张。就周期妊娠率、妊娠时间和总妊娠率来说，迅速治疗比延迟一年后再治疗效果更显著。
几项对比研究发现：对不同分级的精索静脉曲张患者，其睾丸总体积在正常范围（30ml以上），应用外科治疗和放射治疗结果没有差异。因此，对于不存在其他不育因素的不孕夫妇，中度精子精子减少、睾丸体积正常且伴有精索静脉曲张的患者，应该考虑精索静脉曲张的治疗。
处理
l 对于亚临床和Ⅰ度精索静脉曲张需要进一步辅助诊断。
l 可选用介入栓塞术和外科手术治疗。
l 如果精索静脉曲张手术成功后12～24月没有妊娠，根据精液结果按特发性异常处理。
如果有下列合并症，精索静脉曲张的治疗对于最终的妊娠益处有限。
l 亚临床和Ⅰ度精索静脉曲张伴有睾丸总体积（或严重）减小（<30ml）
l 无精子症伴有正常睾丸体积，而且FSH在正常范围（怀疑梗阻性无精子症）
l 无精症伴有FSH的升高，揭示存在生精上皮的严重损伤。
