氧化应激引起精索静脉曲张男性不育的认知与治疗

The Understanding and Treatment of Male Infertility Caused by Varicocele Due to Oxidative Stress

摘要: 精索静脉曲张是一种以精索及睾丸静脉丛异常扩张和迂曲为特征的泌尿生殖系统疾病，其与男性不育之间的密切联系已得到广泛认可。约有15%的男性人口受到精索静脉曲张的影响，其发病机制主要与静脉瓣膜的结构缺陷或功能障碍有关。精索静脉曲张可能导致睾丸组织缺氧、阴囊温度升高及有害代谢物回流，通过不同途径触发活性氧的产生，从而引发氧化应激，对精子的形态、运动能力和遗传物质完整性造成损害从而引起不育。在临床治疗方面，手术疗法包括传统的精索静脉曲张结扎、腹腔镜手术、显微手术技术和介入栓塞治疗是目前主要的治疗选择。这些治疗方法旨在改善精液参数，提高生育率，并可能对氧化应激产生缓解作用。此外，抗氧化治疗作为一种新兴的治疗手段，通过补充抗氧化剂来对抗由精索静脉曲张引起的氧化应激，展现出改善精子质量和提升生育能力的潜力。未来的研究需进一步阐明精索静脉曲张的病理生理过程，并探索更为有效的治疗方法，以优化患者的生殖健康和生育预后。

Abstract: Varicocele, a significant urological and reproductive condition, is defined by the anomalous dilation and tortuosity of the spermatic cord and testicular venous plexus, whose etiology is predominantly associated with structural anomalies or functional impairments of venous valves. This condition is estimated to affect approximately 15% of the male population, resulting in testicular hypoxia, increased scrotal temperature, and the regurgitation of noxious metabolites, which collectively precipitate the generation of reactive oxygen species (ROS), thereby initiating an oxidative stress response. The oxidative stress induced by varicocele is implicated in the detrimental alteration of sperm morphology, motility, and genomic integrity, which collectively contribute to male infertility. Therapeutically, surgical interventions, including conventional varicocelectomy, laparoscopic surgery, microsurgical approaches, and interventional embolization, represent the principal modalities for the management of varicocele. These interventions are aimed at ameliorating semen quality, enhancing fertility potential, and potentially mitigating oxidative stress. Moreover, antioxidant therapy, as a novel therapeutic modality, has demonstrated the potential to rectify the oxidative stress induced by varicocele and to improve sperm quality and fertility outcomes through the administration of antioxidants. Future scholarly endeavors are required to delineate the pathophysiological underpinnings of varicocele and to investigate more efficacious treatment strategies for optimizing the reproductive health and procreative prognosis of affected individuals.