腹腔镜下保留精索内动脉的曲张静脉高位结扎术治疗精索静脉曲张(附42例报告)

Artery preservation during laparoscopic varicocelectomy in adolescents: Report of 42 cases

目的：探讨腹腔镜下保留精索内动脉的曲张静脉高位结扎术治疗精索静脉曲张的临床效果。方法回顾性分析2012年9月至2015年2月在我院实施腹腔镜下高选择性曲张静脉结扎术的42例精索静脉曲张患者术前、术后的临床资料，评估本手术的临床疗效。结果42例患者中39例（92.86%）获得随访6~12月，失访3例。其中术前以阴囊坠胀不适就诊的16例患者13例成功随访，术后症状消失9例（69.23%），减轻3例（23.08%），无改善1例（7.69%）。26例少弱精子症患者均成功随访1年，术前精子密度以及前向运动精子比率分别为（10.18±4.53）＆215;106/mL和（13.32±6.08）%；术后3个月精子密度以及前向运动精子比率分别为（21.83±10.30）＆215;106/mL和（28.49±10.70）%，6个月分别为（21.10±10.25）＆215;106/mL和（29.86±9.87）%。术后精子密度以及前向运动精子比率均较术前显著提高（P＜0.05），但术后3个月和术后6个月精子密度相比以及前向运动精子比率相比均无统计学差异（P＞0.05）。结论腹腔镜下高选择性曲张静脉结扎术治疗精索静脉曲张可改善精索静脉曲张患者阴囊坠胀不适症状，并能较好的提高少弱精子症患者的精子密度以及前向运动精子比率，并且这种手术对精子质量的改善可能在术后3个月处于一峰值。

Objective To investigate the clinical effect of laparoscopic high selective ligation of spermatic vein in the treatment of varicocele.Methods Data on 42 adolescents with varicocele who underwent laparoscopic varicocelectomy by a single urologist at our hospital between September 2012 and February 2015 were retrospectively studied. Age, varicocele grade, and semen parameters were collected, and postoperative data, including the testicular pain, recurrence, semen parameters and catch-up growth were assessed.Results Of 42 patients, 39 （92.86%） follow-up visits at 3, 6 and 12 months after the operation. Of 16 complained of testicular pain or subinguinal approach. Complications were observed and semen parameters detected through follow–up vists at 3 and 6 months postoperation. Testicular pain or discomfort disappeared in 9 of the 13 follow-up patients who had complained of such symptoms, was relieved in 3（23.08%）, and remained unimproved in one case （7.69%）. The 26 followed-up patients with infertility or oligoasthenospermia semen parameters in terms of concentration and motility were （10.18±4.53） million/ml, and （13.32±6.08）%. The postoperative semen parameters in terms of concentration and motility were （21.83±10.30） million/ml, （28.49±10.70）% in 3 months, and （21.10±10.25）million/ ml,（29.86±9.87）% in 6 months. The semen parameters were improved in both 3 months and 6 months postoperative （P〈0.05）. However, no further improvement in these parameters at 6 months after varicocelectomy was noted compared with those at 3 months （P〉0.05）.Conclusion Laparoscopic high selective ligation of spermatic vein can effectively improve symptoms and semen parameters in varicocele patients. It also suggests that the improvement in semen parameters could occur within 3 months after varicocelectomy, and waiting more than 3 months may not result in further improvement.