精索静脉曲张高位结扎手术方法的改良

Improvement in procedures of varicocelectomy

目的探讨精索静脉曲张(VC)高位结扎手术的改良方法,观察改良手术后并发症发生情况。方法回顾性分析78例VC行高位结扎手术的患者,其中改良手术组的28例患者经腹股沟斜切口,回避髂腹股沟神经及髂腹下神经径路,并在术中采取单纯静脉分离结扎,保留睾丸动脉及淋巴管;传统手术组的50例患者采用传统高位结扎手术。分析术后并发症发生情况及精液参数(精子浓度、活动精子的比例和前向运动精子的比例)的变化。结果 78例手术均成功结扎精索静脉。传统手术组患者术后并发症主要为阴囊水肿14例(28.0%),附睾炎10例(20.0%),术后1个月内左侧大腿内侧麻木1例(0.5%);改良手术组患者术后发生阴囊水肿1例(3.6%),附睾炎1例(3.6%),未发现其他短期并发症;改良手术组术后阴囊水肿及附睾炎的发生率显著低于传统手术组(P<0.05)。两组患者术后3～6个月精液参数与术前比较均有显著提高(P<0.05或P<0.01);两组间术后精液参数增加值比较,差异无统计学意义(P>0.05)。结论改良的VC高位结扎术与传统高位结扎术均能显著改善患者精液质量;但改良术式可以有效减少术后并发症。

Objective To investigate the improvement in procedures of varicocelectomy for varicocele （VC）, and observe the incidences of complications after modified operation. Methods Seventy-eight patients with VC undergoing varicocelectomy were studied. Among them, 28 were treated with modified procedures of varicocelectomy, in which the spermatic vein and its main branches were separately ligated and the ilioinguinal nerve, iliohypogastric nerve and lymphatics were protected （ modified varicocelectomy group）. The other 50 patients were managed with traditional varicocelectomy （traditional varicoceleetomy group）. The incidences of complications and semen parameters （sperm concentration, percentage of mobile sperm and percentage of progressively mobile sperm） after operation were analysed. Results Spermatie vein was successfully ligated in all the 78 patients. The complications after operation in traditional varicocelectomy group were hydroeele （ n = 14, 28.0% ）, epididymitis （ n = 10, 20.0% ） and numbness of left inner thigh within 1 month after operation （ n = l, 0.5 % ） . The complications after operation in modified varieoceleetomy group were hydroeele （ n = l, 3.6%） and epididymitis （n = 1, 3.6%）, and there was no other short-term complications. The prevalences of hydrocele and epididymitis after operation in modified varicocelectomy group were significantly lower than those in traditional varicoceleetomy group （P 〈 0.05）. The semen parameters in both modified varicocelectomy group and traditional varicocelectomy group 3 to 6 months after operation were significantly improved （ P 〈 0.05 or P 〈 0.01）. No significant difference was demonstrated in the improvement of semen parameters between two groups （P 〉 0.05）. Conclusion Both the modified procedures of varicocelectomy and traditonal varicocelectomy for VC can improve the sperm quality, while the former can effectively reduce the incidence of complications after operation.