腹腔镜精索静脉高位结扎术后复发的原因及治疗对策

Study on varicocele recurrence after laparoscopic varicocelectomy

目的探讨腹腔镜精索静脉高位结扎术后复发的原因及治疗对策。方法对33例双侧精索静脉曲张经腹腔镜精索静脉高位结扎术后复发的患者，行经腹股沟外环下显微镜精索静脉结扎术。结果33例再手术均获成功，术后随访6个月未见复发，术后3个月27例精液质量提高，占总例数81．8％。结论输精管及提睾肌静脉同时发生曲张是腹腔镜精索静脉高位结扎术后复发的主要原因，术前行内环压迫试验选择合适的手术方式可减少术后复发率；经腹股沟外环下显微镜精索静脉结扎术是治疗腹腔镜精索静脉高位结扎术后复发的有效手段。

Objective To investigate the reason and treatment of varicocele recurrence after laparoscopic varicocelectomy. Methods A total of 33 patients with varicocele recurrence after laparoscopic varicocelectomy underwent subinguinal microscopic varicocelectomy. Results All the operations were successful, and there was no recurrent varicocele during the postoperative follow-up（6 months）. Three months later, the semen quality of 27 patients were enhanced（81.8%）. Conclusion The significant roles of spermaductal and cremaster veins in varicocele recurrence after laparoscopic varicocelectomy were supported. Preoperative pressure test of internal inguinal ring could reduce postoperative recurrence by selecting the appropriate operation method. Subinguinal microscopic varicocelectomy was an effective method for the treatment of varicocele recurrence after laparoscopic varicocelectomy.