| Background Varicocele is the pampiniform venous plexus tortuous and dilated.Varicocele is one of common male clinical diseases,but also caused the most common cause of male infertility.The decrease of semen quality caused by impaired spermatogenic function of the testis is the mean reason of infertility by varicocele.The reason is that the venous blood reflux caused abnormal increase of the metabolites of the testicle,which eventually led to the decline of testicular spermatogenesis and caused infertility.Although semen examination can reflect testicular spermatogenic function,but to get a stable result of semen analysis need a long time.It is easy to fail in the male clinic when sperm retrieve,and the sample is easily disturbed.Laboratory analysis is susceptible to subjective judgment and many other factors,easily lead to the deviation of the analysis results.Therefore,it is very important to find a new,fast and effective auxiliary parameter to evaluate the fertility of the patient.Although conventional ultrasound has been widely used in the diagnosis of varicocele,it can only evaluate the testicular spermatogenesis function from morphological aspects,and cannot reflect the pathological changes of the testis.So it has its limitations,which is not conducive to the convenient and accurate understanding of spermatogenesis function.Ultrasonic elastography has become a practical new ultrasonic technique.It can provide tissue biomechanical information,provide a diagnostic parameter different from conventional ultrasound,and provide objective,stable and valuable quantitative indicators more quickly.Acoustic radiation force impulse(ARFI)is a new noninvasive method to evaluate the hardness of tissue,it reacts the hardness of the tissue by the shear wave velocity(SWV).ARFI has been used to evaluate the tissues of the liver,the mammary gland and the thyroid gland.Therefore,ARFI is expected to detect testicular tissue and evaluate testicular spermatogenesis by detecting the different parts of testicular tissue hardness,so as to provide a new way to evaluate testicular spermatogenesis function.At present,ultrasound elastography has been used to study male reproductive system diseases at home and abroad.However,using ARFI technology to study testicular elastography in patients with varicocele is still less.Therefore,the use the advantages of ultrasound elastography technology in the diagnosis of patients with varicocele is expected to help better evaluate the testicular spermatogenesis function in varicocele patient.Objective This study investigated the relationship between ARFI elasticity value(SWV value)and sperm motility in testicular tissue of patients with varicocele,and studied whether SWV value could predict sperm motility.1.Analyze the change of SWV value at different parts of the testis2.1 Analyze the relationship with the similar SWV value and similar internal diameter of varicoceles at the left and right testicles between the SWV value and sperm motility.2 Analyze whether the relationship with the different SWV value or different internal diameter of varicoceles satisfies the above relationship3.Analyze the relationship between testicular SWV and sperm motility in different groups of varicocele patients.4.Disscuss whether ARFI technique can predict sperm motility in patients with varicoceleMethods72 patients with varicocele diagnosed in our hospital from January 2017 to January 2018 as varicocele group,mean age(33.2 + 5.4)years old(24~46 years old),According to the left varicocele degree,patients with varicocele were divided into subclinical group(n=11),?group(n=23),?group(n=16)and ? group(n=22),and according to the right varicocele degree divided the groups into the corresponding subgroups.15 healthy male subjects due to female infertility factors at the same period as healthy control group,the average age(31.1 + 4)years old(26~41 years old).The German Siemens Acuson S2000 ultrasonic diagnostic instrument with ARFI technology is used,the probe model is 9L4,and the center frequency is 10 MHz.The patients with supine position,fully exposed to the perineum,and use conventional ultrasound in calm breathing state.Then switch to the elastic mode,and avoid the portal area.Measuring stable number and average them were at the 1/3 upper,1/3 middle and 1/3 below area on the testicles.In order to ensure the stability of the data,the patient should keep its breath holding state,and the probe should be placed lightly on the testicular skin,and should not be over oppressed.The routine sperm examination was performed in all the subjects..The testicles with similar SWV value on the left and right side were used to eliminate the elastic difference caused by the varicocele.preliminary draw the relationship between SWV value and sperm motility,and then substitute the difference SWV value of the left and right side into the preliminary relationship to verify the universality.Results1.In this method,the SWV value of the lower part of the testis is different from the SWV value in the upper and middle parts.2.Compared with the control group,the SWV value of the varicocele group was increased(P< 0.01),but the sperm motility was reduced(P < 0.01).3.There was a negative linear correlation between sperm motility and SWV value in varicocele group(y=60.30-52.23 x,R2=0.811,P<0.01).4.With the improvement of the left varicocele level,the SWV value of the left testis increased and the sperm motility decreased(P < 0.01).In the same group,with the improvement of the right varicocele level,the SWV value of the left testis increased and the sperm motility decreased(P<0.01).Conclusions Acoustic radiation force impulse imaging of testicular tissue can predict the sperm motility in varicocele patients in a certain extent. |
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