四种手术方式治疗精索静脉曲张412例临床分析

Clinical Analysis on Four Surgical Methods of 412 Cases with Varicocele

【目的】探讨精索静脉曲张不同手术方式的临床效果。【方法】回顾分析本院1994年5月至2005年4月治疗的412例次精索静脉曲张临床资料,其中经腹股沟管精索静脉结扎58例、腹膜后小切口精索静脉结扎232例、腹腔镜精索静脉结扎80例及经皮穿刺精索静脉栓塞42例。【结果】腹股沟管组复发率最高,并发症多;腹腔镜组、静脉栓塞组住院时间短,损伤小,但费用高;腹膜后组简单安全,疗效可靠。四组均能提高精子活动率、改善活动力,减少精子畸形率。对于不育症治疗,腹股沟组效果差。【结论】腹膜后小切口是精索静脉曲张的首选手术方式;腹腔镜组较适合双侧及复发者;静脉栓塞组易出现严重的并发症,无条件者慎用。

[Objective]To investigate the clinical effect of different treatments of varicocele （Vc）. [Methods]From May 1994 to April 2006,412 patients with Vc in our hospital were treatdd in four different ways and clinical materials were retrospectively analyzed. Among the cases, 58 were treated by ligating internal spermatic vein via inguinal canal, 232 with small incision via retro-peritonium, 80 with laparoscopy and 42 with internal spermatic vein embolism. [Results] The inguinal canal group presented high recurrence and many complications. Laparoscopy and vein embolism were superior in the level of trauma and postoperative stay in hospital while the cost was rather high. Retro-peritonium group was safe, convenient and effective. All methods were able to raise the percentage of sperm motility, and to increase sperm viability and decrease the rate of teratospermia. But the inguinal canal group had less help for infertility. [Conclusion] Small incision via retroperitonium is the first choice for patients with unilateral varicocele. Laparoscopy is recommended for recurrent and bilateral varicocele. Vein embolism should be used cautiously for its severe complications.