显微镜外环下精索静脉结扎与精索内静脉高位结扎术治疗重度精索静脉曲张的比较

Clinical efficacy and safety evaluation of microsurgical subinguinal varicocelectomy versus high retroperitoneal varicocelectomy in the treatment of massive varicocele

目的比较显微镜外环下精索静脉结扎术(MSV)与腹膜后精索内静脉高位结扎术(HRV)治疗重度精索静脉曲张(VC)的临床疗效及安全性。方法收治的双侧重度VC患者随机分为显微镜外环下精索静脉结扎术组(MSV组)与腹膜后精索内静脉高位结扎术组(HRV组)64例。比较两组年龄(PA)、精索静脉宽度(VCW)、手术时间(OT)、术中出血(BL)、术后住院时间(HST)、精索静脉曲张复发率(VRR)、睾丸鞘膜积液发生率(HI)、睾丸萎缩率(TAR)、自然怀孕率(PR)、精子密度(SC)、精子活力(SM)、精子畸形率(SDR)、精子质量改善率(SQIR)、阴囊VAS疼痛评分、阴囊疼痛缓解率(SPRR)、IIEF-5评分及血清促卵泡素(FSH)、促黄体生成素(LH)、睾酮(T)、游离睾酮(FT)等情况。结果两组间PA、VCW、BL、SPRR、HI及TAR无明显差异(P>0.05)。MSV组OT大于HRV组(P<0.01),MSV组术后PR、SQIR大于HRV组(P<0.05),MSV组术后VRR小于HRV组(P<0.05),MSV组术后HST小于HRV组(P<0.01)。两组间患者术前术后LH、FSH、T、FT、阴囊VAS疼痛评分、IIEF-5评分及术前SC、SM、SDR无显著性差异(P>0.05),两组术后SC、SM及SDR均较术前有明显改善(P<0.01),MSV组术后SC、SM大于HRV组(P<0.01),MSV组的术后SDR低于HRV组(P<0.01)。结论 MSV治疗重度VC可更有效改善精子质量,增加怀孕率,具有满意疗效,同时具备恢复快、并发症少等优点。

Objectivet Objective To evaluate the clinical efficacy and safety of microsurgical subinguinal varicocelectomy（MSV） and high retroperitoneal varicocelectomy（HRV） in the treatment of massive varicocele（VC）. Methods Methods The patients with bilateral massive varicocele were randomly divided into MSV group and HRV group. The patient age（PA）, VC width（VCW）, operation time（OT）, intraoperative blood loss（BL）, postoperative hospital stay time（HST）, postoperation hydrocele incidence（HI）, varicocele relapse rate（VRR）, testicular atrophy rate（TAR）, pregnancy rates（PR）, semen concentration（SC）, semen motility（SM）, semen deformation rate（SDR）, sperm quality improvement rate（SQIR）, scrotum VAS pain score, scrotum pain relief rate relief rate（SPRR）, IIEF-5 score, follicle-stimulating hormone（FSH）, luteotropic hormone（LH）, testosterone（T） and free testosterone（FT） in serum were analyzed retrospectively. Results Results There was no differences in PA, VCW, BL, SPRR, HI, TAR, preoperative SC, SM, SDR, preoperative and postoperative LH, FSH, T, FT, VAS pain score, IIEF-5 score between the two groups（P 0.05）. The postoperative SC, SM, and SDR was significantly improved in the two groups（P 0.01）. The postoperative PR and SQIR in the MSV group was higher than that in the HRV group（P 0.05）. The postoperative VRR in the MSV group was lower than that in the HRV group（P 0.05）. The OT, postoperative SC and SM in the MSV group was higher than that in the HRV group（P0.01）. The VRR in the MSV group was lower than that in the HRV group（P 0.05）. The SDR and HST in the MSV group was lower than that in the HRV group（P 0.01）. Conclusion Conclusion MSV can improve sperm quality and increase PR with satisfactory efficacy. MSV has more advantages and fewer complications, but long-term therapeutic effect of MSV needs to be further investigated.