显微外科曲张精索静脉结扎术治疗精索静脉曲张(附94例报告)

Treatment of varicocele by microsurgical varicocelectomy:Report of 94 cases

目的:探讨显微外科曲张精索静脉结扎术治疗精索静脉曲张的临床效果。方法:回顾分析2008年8月至2011年2月显微外科术治疗94例精索静脉曲张患者的临床资料。94例中,主要因睾丸坠胀不适、疼痛等症状就诊者36例;主要因不育或少弱精子症就诊者58例。经腹股沟途径或外环口下途径行显微外科曲张精索静脉结扎术,术后1、3、6个月随访相关并发症及精液参数改善等情况。结果:获得随访6个月至2年的患者88例,失访6例。术前主要以睾丸坠胀不适、疼痛等症状就诊获得随访的32例患者,术后症状消失者21例(65.6%),减轻6例(18.8%),无改善5例(15.6%)。获得随访的56例不育或少弱精子症者术前精子浓度及活力为[(a+b)%]为(8.26±1.68)×106/ml、(5.25±1.09)%,术后3个月及6个月分别为(15.47±3.21)×106/ml、(18.39±4.05)×106/ml和(13.34±5.16)%、(17.23±4.69)%,均较术前显著改善(P均<0.01)。结论:显微外科曲张精索静脉结扎术治疗精索静脉曲张可有效改善睾丸疼痛、坠胀不适等症状,并提高精子浓度和活力。

Objective： To investigate the clinical effect of microsurgical varicocelectomy in the treatment of varicocele.Methods： We retrospectively analyzed the clinical data of 94 varicocele patients treated by microsurgical varicocelectomy,of whom 36 complained of testicular pain or dragging and distending discomfort,and 58 infertility or oligoasthenospermia.Microsurgical varicocelectomy was performed through inguinal or subinguinal approach.Complications were observed and semen parameters detected through follow-up visits at 1,3 and 6 months after the operation.Results： Testicular pain or discomfort disappeared in 21（65.6%） of the 32 followed-up patients who had complained of such symptoms,was relieved in 6（18.8%）,and remained unimproved in the other 5（15.6%）.The 56 followed-up patients with infertility or oligoasthenospermia all showed significantly improved sperm concentration and motility（grade a ＋ b sperm）,（15.47 ± 3.21） × 106/ml and（13.34 ± 5.16）% at 3 months,and（18.39 ± 4.05） × 106/ml and（17.23 ± 4.69）% at 6 months after operation,as compared with（8.26 ± 1.68） × 106/ml and（5.25 ± 1.09）% preoperatively（P0.01）.Conclusion： Microsurgical varicocelectomy can effectively improve symptoms and semen parameters in varicocele patients.