改良隐匿式切口腹股沟下显微镜精索静脉结扎术的临床观察

Clinical Effect of Modified Microsurgical Subinguinal Varicocelectomy through Hidden Incision

目的利用多普勒彩超测定术前术后睾丸动脉血流参数及精液参数分析评价改良隐匿式切口显微技术腹股沟下精索静脉结扎术的疗效。方法笔者对26例临床诊断为左侧精索静脉曲张的患者采用改良腹股沟下隐匿式切口显微镜技术治疗（腹股沟下隐匿式小切口，睾丸不提出切口外，保留睾丸引带静脉及精索外静脉穿支），在术前及术后3、6、12个月采用彩色多普勒超声测定双侧睾丸动脉血流参数：收缩期峰值血流速度（PSV），舒张末期血流速度（EDV）和阻力指数（RI）。并同时分析术前及术后3、6个月精液参数，观察腹股沟管下途径显微镜技术治疗精索静脉曲张的远期疗效。结果术后随访6～21个月，平均随访13．6个月，术后左侧睾丸内动脉收缩期峰值血流速度较术前提高（P〈0．05），阻力指数较术前降低（P〈0．05），差异有统计学意义。术后3、6个月精子浓度较术前改善（P〈0．01），差异有统计学意义，而精子活力（精子前向运动）无明显改善（P〉0．05），差异无统计学意义。随访过程中，无一例复发，无一例术后出现睾丸萎缩等严重并发症。结论改良隐匿式切口腹股沟下显微镜技术治疗精索静脉曲张能明显改善睾丸血流及精液参数，术后并发症少，安全有效。

Objective To investigate the clinical effect of modified microsurgical subinguinal varieocelectomy on semen parameter and testicular blood flow using color Doppler sonography（CDS）. Methods A total of 26 patients diagnosed with Left varicocele who un- derwent modified microsurgical subinguinal technique through hidden incision（ division of the spermatic cord before microsurgical dissec- tion, and the testes were not delivered ） were examined by color Doppler sonography（CDS） for testicular blood flow parameters and semen parameters before, operation then 3 months, 6 months,and finally 12 months after operation for 4 times. Testicular blood flow parameters including peak systolic velocity（PSV） ,end diastolic velocity（EDV） , resistive index（RI） were measured from testicular artery. Results The follow- up was 13.6 months（range from 6 to 21 ）. The mean values of peak systolic velocity（PSV） and end diastolic velocity in- creased significantly after surgery（ P 〈 0.05 ） , and resistive index decreased significantly after surgery （ P 〈 0.05 ） , compared to preopera- tive, Semen parameters showed significant improvement in sperm concentration and sperm viability, but sperm forward progression per- centage wan not significantly different. During the follow - up, no recurrence, no testicular atrophy and other serious complications hap- pened. Conclusion Our data showed that a significant improvement occured in sperm and testicular blood supply parameters after modifi- cation of the standard mierosurgieal subinguinal technique through hidden incision. It is a safe and reliable procedure with good results, minimal surgical morbidity for varieocele.