三种精索静脉曲张手术方法治疗与疗效比较

Comparison of curative effect of three kinds of operation method for varicocele

目的对比评价经腹腔镜、经腹膜后开放手术及经显微镜下治疗精索静脉曲张的临床应用价值及疗效、术前术后生育能力等比较。方法随机选择我院2005至2013年因精索静脉曲张收治的85例患者，采取三种不同手术方法治疗。结果三种不同的手术方法术后都恢复较快。随访无复发和睾丸萎缩。77例患者术后精液质量有不同程度的改善。患者精子数及活动率明显增高，手术前后比较存在显著差异（P〈0．01），术后妊娠率达25％。8例患者术后生精功能改善不明显，提示术前精子数〈10×10^6／ml者。结论不论精索静脉曲张程度如何，一旦发现精液质量不好，并可排除其它原因，应尽早手术。对于一侧精索静脉曲张患者采取三种手术方法无明显差异，双侧和复发的精索静脉曲张优先考虑腹腔镜手术。

Objective To evaluate clinical application value and curative effect of laparoscopic, retroperitoneal open operation and microscopical treatment of varicocele. Method 85 cases of varicocele who were treated with three kinds of operation method in our hospital from 2005 to 2013 were randomly selected. Results All patients selected had fast recovery after surgery, without recurrence and atrophy of testis. Sperm quality in 77 patients improved in varying degrees after surgery. Sperm count and activity rate after operation were significantly higher than those before operation, with statistically significant difference （P 〈 0.01）. Postoperative pregnancy rate was 25%. Spermiogenesis function in 8 patients did not improve obviously after surgery, whose preoperative sperm count was 〈 10 × 10^6/ml. Conclusions Regardless of the degree of varicocele, once bad semen quality is found, and other causes ruled out, operation should be taken as soon as possible. There is no difference between three kinds of operation method for side varicocele, laparoscopic surgery is more appropriate for recurrent and bilateral varicocele.