显微镜辅助下精索静脉结扎治疗精索静脉曲张手术效果观察

Investigation of the ligation effect of the cord vein under the microscope in patients with VC

目的观察显微镜辅助下精索静脉曲张(VC)患者进行精索静脉结扎的手术效果。方法选取2012年1月至2015年4月收治的行显微镜下精索静脉结扎术治疗的40例VC患者作为研究对象,同时选取同期行腹腔镜下精索静脉结扎术治疗的40例VC患者进行对照。对两组患者的手术时间、住院时间、切口疼痛程度、术后并发症情况进行比较,同时对所有患者进行随访,比较两组手术前后精液质量指标变化情况及术后6个月复发率。结果显微镜组患者的手术时间明显大于腹腔镜组,但住院时间、术后2 h切口视觉模拟评分(VAS评分)均明显小于腹腔镜组(P<0.01);两组患者术后3个月、6个月精子密度、前向运动、精子正常形态均较术前有明显改善,而术后6个月较术后3个月又有明显改善,其中显微镜组术后6个月精子密度、前向运动较腹腔镜组改善更为明显(P<0.01);显微镜组术后无睾丸鞘膜积液或阴囊水肿发生,术后6个月无VC复发。腹腔镜组术后睾丸鞘膜积液或阴囊水肿发生率、术后6个月VC复发率分别为12.50%、10.00%,显微镜组术后并发症发生率、复发率明显低于腹腔镜组(P<0.05)。结论显微镜下精索静脉结扎术相对于腹腔镜下精索静脉结扎术尽管手术时间长,但手术疗效更为确切,术后并发症少,复发率低,精子质量改善更为明显。

Objective To investigate the operation effect of the ligation of the cord vein under the microscope in patients with VC. Methods 40 cases of patients with VC undergoing the operation of the ligation of the cord vein under the microscope in our hospital from January 2012 to April 2015 were selected as the study subjects,and another 40 patients with VC treated by laparoscopic ligation of the cord vein were selected as the control group at the same period. The operation time,the hospitalization time,incision pain and postoperative complications were compared between the two groups,and all patients were followed up. The changes of semen quality index before and after operation and the recurrence rates after 6 months after operation were compared between the two groups. Results The operation time of the microscope group was significantly longer than that of the laparoscopic group,but the hospitalization time,2 h incision and VAS scores were significantly less than those in the laparoscopic group（ P〈0.01）. The sperm density,the forward movement and normal sperm morphology of the patients in two groups after three months,six months of operation improved a lot than those before the operation. The improvement after six months of operation was better than that after three months of operation. After six months of operation,the sperm density and the forward movement of the patients in the microscope group were significantly improved,compared with those of the laparoscopic group（ P〈0.01）. There was no testicular hydrocele or scrotal edema after operation in the microscope group,and there was no recurrence of VC after 6 months. The postoperative hydrocele of tunica vaginalis or scrotal edema rate and postoperative 6 months VC recurrence rate were respectively 12. 50% and 10. 00%. The complication rate and recurrence rate in the microscope group were significantly lower than those in the laparoscopic group（ P〈0.05）. Conclusion Although the operation of ligation of the cord vein under the microscope needs a longer time under the microscope than the laparoscopic ligation of the internal cord vein,its effect has less complication and low recurrence rate,and the improvement of sperm quality is more obvious.