Клинико-экономическая эффективность варикоцелэктомии при лечении мужского бесплодия
Варикоцеле остается наиболее частой потенциально корректируемой причиной мужского бесплодия. В обзоре суммированы данные руководств, систематических обзоров, метаанализов и оригинальных исследований о клинической и клинико-экономической эффективности его лечения. У мужчин с клиническим варикоцеле и нарушениями сперматогенеза хирургическая коррекция улучшает параметры эякулята, включая число прогрессивно подвижных сперматозоидов, и повышает вероятность естественной беременности. Перед ВРТ операция ассоциирована с более высокими показателями клинической беременности и живорождения и может быть экономически выгодной за счет повышения эффективности ВРТ. При тяжелой олигозооспермии микрохирургия у части пациентов позволяет перейти к ВМИ или отсрочить ЭКО/ИКСИ. При НОА операция может способствовать появлению сперматозоидов в эякуляте и повышать вероятность их получения при micro-TESE, однако устойчивого экономического преимущества стратегии «операция-сначала» перед непосредственным micro-TESE+ИКСИ не показано. Антиоксидантная терапия умеренно улучшает семенные показатели и снижает фрагментацию ДНК сперматозоидов, но ее влияние на клиническую беременность и живорождение остается недостаточно доказанным. Среди методов коррекции варикоцеле микрохирургическая субингвинальная техника демонстрирует наиболее благоприятный профиль эффективности, безопасности и рецидивов. Лапароскопические и эндоваскулярные методы остаются валидными альтернативами, тогда как робот-ассистированные и экзоскопические технологии требуют дополнительных данных по клинической и экономической эффективности. В целом доказательная база остается неоднородной; необходимы крупные проспективные исследования с конечными точками «клиническая беременность» и «живорождение» для уточнения эффективности и рентабельности различных подходов.Шомаруфов А.Б., Божедомов В.А., Гиясов Ш.И.
Ключевые слова
варикоцеле
мужское бесплодие
варикоцелэктомия
вспомогательные репродуктивные технологии
клинико-экономическая эффективность
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Об авторах / Для корреспонденции
А в т о р д л я с в я з и: А.Б. Шомаруфов – к.м.н., доцент кафедры урологии Ташкентского государственного медицинского университета, врач-консультант, ГУ «Республиканский специализированный научно-практический медицинский центр урологии», Ташкент, Узбекистан; e-mail: doctor.shomarufov@gmail.comТакже по теме
