腹股沟下显微精索静脉结扎术与腹膜后精索内静脉高位结扎术疗效比较

Comparison of clinical efficacy between subinguinal microsurgical varicocelectomy and high retroperitoneal varicocelectomy

目的探讨腹股沟下显微精索静脉结扎术与腹膜后精索内静脉高位结扎术治疗精索静脉曲张的疗效差异。方法收集233例精索静脉曲张患者,其中行腹股沟下显微精索静脉结扎术146例（显微手术组）,行腹膜后精索内静脉高位结扎术87例（高位结扎术组）,术后随访6~12个月,比较2组术中结扎的精索内静脉条数、手术时间,评价手术疗效。结果显微手术组和高位结扎术组术中精索内静脉平均结扎条数分别为13.7条和1.8条（P〈0.001）,平均手术时间分别为83.8 min和31.4 min（P〈0.001）,术后复发率分别为2.3%和15.0%（P=0.001）,男性不育患者术后配偶自然妊娠率分别为48%和26%（P=0.034）,精液改善率分别为84%和63%（P=0.004）,疼痛缓解率分别为89%和62%（P=0.025）,2组均未见睾丸萎缩和鞘膜积液发生。结论与精索内静脉高位结扎术相比,腹股沟下显微精索静脉结扎术术中结扎的精索静脉条数更多,术后复发率较低,并有较高的自然妊娠率、精液改善率和疼痛缓解率,但手术时间较长。

Objective To statistically compare the clinical efficacy between subinguinal microsurgical and high retroperitoneal varicocelectomies in the treatment of varicocele. Methods Among 233 patients with varicocele enrolled in this study,146 receiving subinguinal microsurgical varicocelectomy were assigned in the microscopic surgery group and the other 87 undergoing high retroperitoneal varicocelectomy in the high ligation group. Postoperative follow up endured for 6 ~ 12 months. The number of internal spermatic veins ligated intraoperatively,operating time and postoperative efficacy were statistically compared between two groups. Results The mean number of internal spermatic veins ligated intraoperatively in the microscopic surgery and high ligation groups were 13. 7 and 1. 8（ P〈0. 001）,the mean operating time was 83. 8 min and 31. 4 min（ P〈0. 001）,the recurrence rates were 2. 3% and 15. 0%（ P = 0. 001）,the spontaneous pregnancy rates were48% and 26%（ P = 0. 034）,the improvement rates of semen quality were 84% and 63%（ P = 0. 004） and the rates of pain alleviation were 89% and 62%（ P = 0. 025）. No incidence of testicular atrophy and / or hydrocele was identified in either group postoperatively. Conclusions Compared to high retroperitoneal varicocelectomy,subinguinal microsurgical varicocelectomy yields a larger number of internal spermatic veins intraoperatively ligated,lower reccurrence rate and higher rates of spontaneous pregnancy,semen quality improvement and pain alleviation. However,the operating time of subinguinal microsurgical varicocelectomy is longer.