小切口集束型腹膜后精索静脉高位结扎术在精索静脉曲张伴不育患者中的应用

The Application of High-position Small Incision of Ligation of Spermatic Vein in Patients with Varicocele Infertility

目的探讨小切口集束型腹膜后精索静脉高位结扎术治疗精索静脉曲张伴不育患者的疗效。方法 98例精索静脉曲张患者随机分为两组:小切口集束型腹膜后精索静脉高位结扎术治疗(简称小切口组)和传统腹腔镜手术治疗组(简称腹腔镜组),每组各49例。小切口组在局部麻醉下行小切口集束型腹膜后精索静脉高位结扎术,腹腔镜组在硬膜外麻醉下行腹腔镜手术治疗,比较两组患者术中血气指标变化,比较术前和术后3月精液改善率指标。结果术后小切口组患者PO2、SaO2、HhO2以及pH值明显高于腹腔镜组(P<0.05),PCO2则明显低于腹腔镜组(P<0.05);两组患者术后3月精子密度、精子活动度均显著高于手术前(P<0.01),精子畸形率明显下降(P<0.01)。术后3月两组患者精子密度、精子活力以及精子畸形率比较差异不明显(P>0.05)。结论小切口集束型腹膜后精索静脉高位结扎术具有损伤较小,恢复较快,安全性较高以及住院费用较低等优点。

Objective Research on the effect of high-position small incision of ligation of spermatic vein in patients with varicocele infertility.Methods 98 cases of patients with varicocele infertility were randomly divided into two groups：49 cases were operated by high-position small incision of ligation of spermatic vein（for short,small incision group）.49 cases were operated by laparoscopic high ligation of spermatic vein（for short,laparoscopic group）.Small incision group under local anesthesia were operated by high-position small incision of ligation of spermatic vein.Laparoscopic group under epidural anesthesia were operated by laparoscopic high ligation of spermatic vein.Two groups of patients undergoing blood gas analysis were compared,preoperative and 3 months postoperative semen improvement rate was compared.Results PO2、SaO2、HhO2 and pH in small incision group were significantly higher than those in laparoscopic group（P0.05）.PCO2 in small incision group were significantly lower than those in laparoscopic group（P0.05）.3 months after operation,sperm density and sperm activity in both two groups was significantly higher than before surgery,sperm malformation rate in both two groups was significantly decreased（P0.01）.3 months after surgery,sperm density,sperm motility and sperm deformity rate in two groups were no obvious difference.Conclusion Patients operated by high-position small incision with less damage,recover faster,it is also much safer and less cost.