显微镜下精索静脉结扎治疗精索静脉曲张的临床应用

Clinical Application of Varicocele Ligation in the Treatment of Varicocele Under Microscope

目的探讨显微外科技术结扎精索静脉治疗精索静脉曲张的疗效及安全性。方法选取2015年4月—2016年9月于浙江省丽水市云和县人民医院治疗的精索静脉曲张患者共25例作为显微镜组,选择同期于本院采用腹腔镜治疗的患者共25例作为腔镜组,比较分析两组患者的手术时间、住院时间,对比两组患者术前、术后精液质量改善情况,性激素变化,术后并发症、术后自然孕率及术后复发率。结果两组患者的年龄、患病时间、精索静脉曲张程度为Ⅱ度和Ⅲ度的比例、单双侧患病的比例、手术时间、住院时间、术后复发率对比,差异均无统计学意义(P>0.05);术前的精子密度、精子活力、促性腺激素(FSH)、黄体生成素(LH)和睾酮(T)对比,差异无统计学意义(P>0.05);术后显微镜组患者的精子密度、精子活力、T、自然孕率均高于腔镜组,显微镜组患者的FSH、LH、总并发症均低于腔镜组,差异有统计学意义(P<0.05)。结论显微镜下精索静脉结扎治疗精索静脉曲张能提高精子质量,改善患者性激素分泌,提高自然受孕,改善并发症,其临床疗效优于腹腔镜手术。

Objective To investigate the efficacy and safety of microsurgical technique in the treatment of varicocele.Methods 25 cases of varicocele patients treated in Yunhe People Hospital,in Zhejiang Province from April 2015 to September 2016 were selected as the microscope group. 25 patients with laparoscopic treatment( laparoscopic group) were selected as control group. The operative time and length of hospitalization were compared between the two groups. The improvement of preoperative and postoperative semen quality,changes of sex hormones,postoperative complications,postoperative natural pregnancy rate and recurrence rate also were compared. Results There were no significant differences in the age,duration of illness,the proportion of varicocele in the two groups,the ratio of Ⅱ and Ⅲ,the ratio of single and bilateral disease,the time of operation,the length of hospitalization and the recurrence rate( P > 0. 05). Preoperative sperm density, sperm motility, gonadotropin( FSH),luteinizing hormone( LH) and testosterone( T),the difference was not statistically significant between the two groups( P > 0. 05). The sperm density,sperm motility,T and natural pregnancy rate were higher in the postoperative microscope group than those in the endoscopy group. The total complications of FSH and LH were lower in the microscope group than those in the endoscopy group, the difference was statistically significant( P < 0. 05). Conclusion Microscopic varicocele ligation can improve the quality of spermatozoa, improve the secretion of sex hormones, improve the natural conception, improve the complications,the clinical efficacy is better than laparoscopic surgery.