不保留精索内动脉治疗精索静脉曲张的临床应用

Effect of artery-ligating and artery-preserving varicocelectomy in infertile men with varicocele

目的观察经腹膜后途径不保留精索内动脉治疗精索静脉曲张的手术效果,探讨其临床应用。方法 210例左侧精索静脉曲张伴不育患者随机分成两组,不保留精索内动脉手术组(动脉不保留组)89例,保留精索内动脉手术组(动脉保留组)121例;比较两组患者的手术时间、术前及术后半年精液质量、复发率。结果动脉不保留组的手术时间明显短于动脉保留组(P<0.05);动脉不保留组的术后复发率明显低于动脉保留组(P<0.05);两组患者术后半年精液密度、活力均较术前有明显改善,且两组改善率差异无统计学意义(P>0.05)。结论经腹膜后不保留及保留精索内动脉的手术方式治疗精索静脉曲张均能显著改善患者精液质量,但不保留精索内动脉的手术方式手术时间更短、复发率更低。

Objective To evaluate the clinical effects of ligation of the internal spermatic artery at varicocelectomy in infertility with single - side primary varieocele by conducting a prospective randomized study for comparison of two surgical methods （ artery - ligated and ar- tery - preserved）. Methods This study included 210 infertile patients with single - side varicocele, all patients were randomly assigned to an artery -ligated or artery -preserved group at varicoeelectomy. The change in seminal characteristics, the operation time and the rate of complication were prospectively investigated. Results Sperm density and motility improved significantly in both groups, but this study did not show any significant difference between artery - ligating and artery - preserving varicoceleetomy in terms of the improvements in semen quality. The operation time was significantly shorter in artery - ligated group than in the other group. Moreover, postoperative recurrence rate in artery - ligated group was markedly lower than in artery - preserved group, but no significant difference in hydrocele formation rate was indicated. Conclusion Both artery - ligating and artery - sparing varicocelectomy can improve semen quality in infertile men with varicocele, but the former is even more preferable for its shorter operation time and less recurrence rate.