精索静脉曲张5种术式的疗效及并发症的对比观察

Effects and complications of five surgical approaches to the treatment of varicocele:A comparative study

目的:比较显微镜下腹股沟径路、腹腔镜经腹径路、腹腔镜腹膜外径路、传统开放精索静脉高位结扎术和逆行介入栓塞术5种精索静脉曲张手术治疗精索静脉曲张的疗效及并发症。方法:回顾分析632例精索静脉曲张患者,按不同手术方式共有5组:显微镜下精索静脉结扎术组(79例)、腹腔镜经腹径路组(120例)、腹腔镜腹膜外径路(137例)、传统精索静脉高位开放手术组(283例)、介入栓塞组(13例),比较术前、术后3个月的精液质量、术后并发症,以及术后配偶妊娠率。结果:显微镜组和介入栓塞组手术时间最长[(2.02±1.25)h和(2.17±1.02)h];介入栓塞术组术后住院天数最短,仅(1.1±0.1)d;术中并发症(出血、肠道损伤等)腹腔镜经腹径路组2例,介入栓塞组有1例。术后阴囊水肿发生率介入栓塞组为0,显微镜组、腹腔镜经腹径路、腹腔镜腹膜外径路组、传统高位开放手术组分别为3.7%、17%、10%、19%;术后1年复发率显微镜组最低(1.6%),而介入栓塞组最高(22%)。各组术后精子浓度、前向运动(PR)精子百分率、正常形态精子百分率均较术前明显提高(P<0.05),但各组间无统计学差异。配偶妊娠率各组无明显差异(P>0.05)。结论:在目前5种精索静脉曲张手术方式中,腹腔镜腹膜外径路手术时间短,并发症少,适宜手术量大的男科应用;显微外科精索静脉结扎术创伤小、恢复快、术后并发症少、复发率最低,是今后的发展方向,但手术时间相对较长,需要专门显微镜和显微外科培训。介入栓塞术可局部麻醉下进行,无手术刀疤,术后恢复最快。

Objective： To compare the effects and complications of subinguinal microscopic ligation, laparoscopie transperitoheal varieocelectomy, laparoseopic retroperitoneal varicoeelectomy, open retroperitoneal high ligation, and interventional embolotherapy in the treatment of varicocele. Methods ： We conducted a retrospective study that included 632 varicocele patients treated by subinguinal microscopic ligation （ group A, n = 79）, laparoscopic transperitoneal varicocelectomy （ group B, n = 120 ）, laparoseopic retroperitoneal varicoeelectomy （group C, n = 137） , open retroperitonea[ high ligation （group D, n = 283 ）, and interventional embolothe- rapy （group E, n = 13）. We compared the baseline and 3-month postoperative semen parameters, postoperative complications, and pregnancy rate among the five groups of patients. Results ： The operation time was longer in groups A （ [ 2.02 ± 1.25 ] h） and E （ [ 2.17 ±1.02 ] h） than in the other three groups, while the postoperative hospital stay was the shortest in group E （ [ 1.1 ± 0. 1 ] d）. Intestinal injury or incision bleeding occurred intraoperatively in 2 cases in group B and 1 case in group E. Postoperative serotal edema developed in 3.7, 17, 10, and 19% of the patients in groups A, B, C, and D, respectively, but not in group E. The rate of 1-year recurrence was the lowest in group A （1.6%） and highest in group E （22%）. Sperm concentration and the percentages of progressively motile sperm and morphologically normal sperm were improved postoperatively in all the patients （P 〈 0.05 ）, but there were no statistically significant differences among the five groups either in the above three parameters or in the postoperative pregnancy rate （ P 〉0. 05 ）. Conclusion ： In the surgical treatment of varicocele, laparoscopic retroperitoneal approach involves short operation time and few complications, subinguinal microscopic ligation has the advantages of little injury, rapid recovery, and few complications but requires specialized microsurgical techniques, and interventional embolotherapy leaves no incision scar and needs only local anesthesia and 1-day postoperative hospital stay, which is uitable for those with a contraindication to anesthesia.