显微镜与腹腔镜下精索静脉结扎术治疗精索静脉曲张的疗效比较

Curative effects analysis of spermatic vein ligation under microscope and laparoscope for varicocele treatment

目的比较显微镜下精索静脉低位结扎术和腹腔镜下精索静脉高位结扎术治疗精索静脉曲张（VC）的疗效。方法前瞻性分析Ⅱ度以上原发性VC患者140例，随机分2组进行治疗。A组：显微镜下精索静脉低位结扎术组70例：B组：腹腔镜下精索静脉高位结扎术组70例。术前两组在年龄、婚姻、患病的单双侧等方面的差异经检验无统计学意义。比较两种治疗方法的手术时间、术后住院时间及住院费用；对比两组术后阴囊水肿，睾丸萎缩，复发等近、远期并发症及精液改善和生育情况。结果140例患者中，平均住院时间A组（2．7±0．5）d，B组（3．1±0．7）d；平均手术时间A组（31．0±10．1）min，B组（29．3±8．2）min，这两项两组比较差异均无统计学意义。中位住院费用A组2956元，B组5847元，两组比较差异有统计学意义（P〈0．05）。术后7d阴囊水肿A、B组发生率分别为1．4％（1／70）、7．1％（5／70），两组比较差异有统计学意义（P〈0．05）。A、B组术后6个月复发率分别为2．8％（2／70）、4．2％（3／70）；术后3个月睾丸萎缩发生率分别为1．4％（1／70）、2．8％（2／70）；两组比较差异无统计学意义（P〉0．05）。A组术后6个月精液质量提高率高于B组（P〈0．05）。A、B组术后2年内配偶自然受孕率分别为55．7％（39／70）和52.8％（37／70），组间比较差异均无统计学意义（P〉0．05）。结论显微镜下精索静脉低位结扎术和腹腔镜下精索静脉高位结扎术治疗VC都是简单、有效的治疗方式，但前者更经济，便于基层推广。

Objective To compare the effects of microscopic spermatic vein low ligation and laparoscopic spermatic vein high ligation for varicocele treatment. Methods 1 Total 140 40 primary varicocele patients with II-III degree were randomly divided into Group A （70 cases who undwent microscopic spermatic vein low ligation） and Group B（70 cases who undwewent laparoscopic spermatic vein high ligation）according to different treatment methods. There were no statistical differences between two groups in age, marriage and lesion before operation. Operating time, postoperative hospitalization days and hospitalization expenses were comparatively analyzed between these two groups. Scrotal edema, testicular atrophy, recurrence, semen improvement and child birth after operation were also comparativelyanalyzed. Results There were no statistical differences between two groups in average postoperative hospitalization days and operation time. A significant difference in median hospitalization expenses ween two groups was found （P 〈 0.05）. The rates of scrotal edema within 7 days after operation in group A and group B were 1.4%（1/70） and 7.1%（5/70）,respectively（P 〈 0.05）. There were no significant differences in the rates of recurrence and testicular atrophy after operation between group A and group B. The rate of semen quality improvement within 6 months after surgery in group A was higher than that ingroup B （P 〈 0.05）. There was no statistical difference between two groups in child birth. Conclusion Both microscopic spermatic vein low ligation and laparoscopic spermatic vein high ligation are simple and effective ways for varicocele treatment, but the former is more economical and facilitates grassroots promotion.