精索静脉曲张不同手术方式对精液质量的影响

The comparing of the semen quality of different operation method of varicocele with 561 cases

目的比较高选择性精索静脉高位结扎术、经腹股沟管人路精索静脉结扎术和腹腔镜下改良的palomo术三种手术方式治疗精索静脉曲张后患者精液质量的变化。方法回顾性分析Ⅱ度以上、因不育而就诊的精索静脉曲张患者561例，根据不同的手术方式分为三组：高选择性精索静脉高位结扎术组为A组，共300例；B组为经腹股沟管人路精索静脉结扎术组，共181例；C组为腹腔镜下改良的palomo术组，共80例。通过对比观察三组精液质量改善和生育情况来评价不同手术方式对患者生育能力的影响。结果30岁以下患者A组术后3—6个月精液质量提高率和术后1～2年内患者妻子自然妊娠率高于其他两组（P〈0．05），而30岁以上患者之间精液质量提高率和术后1～2年内各组患者妻子自然妊娠情况，差异无统计学意义（P〉0．05）。各组30岁以下患者精液质量改善率高于30岁以上患者（P〈0．05）。结论高选择性精索静脉高位结扎术简单且术后精液质量提高率和术后1～2年内患者妻子自然妊娠率高，值得临床推广。

Objective To research the effect to the semen quality of the three operation methods of superiority of highly selective v aricocele high ligation ,transinguinal canal and laparoscopic of renovated polomo management of varicocele. Methods 561 patients in our hospital who charged by infertility had the operation were analyzed retrospectively and were recruited with primary varicocele above grade Ⅱ for this study. These patients were divided into three group according to three kinds of operation methods of varicocele ： group A was treated with highly selective varicocele high ligation and had 300 patients;group B was treated with transinguinal canal operation and had 181 patients ; and group C was treated by laparoscopic of renovated polomo operation with 80 patients. Through the comparing of the fertility ability of the three operation methods ,to evaluate the therapeutic effect of the three methods. Results The increasing rates of the quality of semen in group B was higher than other groups if patients＇ ages were lower than 30. The increasing rates of the quality of semen in every group was also higher if patients＇ ages were lower than 30. No difference was found between three groups in natural conception rate （ P 〉 0.05 ）. Conclusion The methods of highly selective varicocele high ligation would be a better choice in the management of patients with primary varicocele because of higher quality of semen.