单孔腹腔镜与显微外科治疗精索静脉曲张的临床疗效与安全性比较

Clinical efficacy and safety of low-approach microscopic and single port laparoscopic varicocelectomy in the treatment of varicocele

目的:探讨单孔腹腔镜与显微外科治疗精索静脉曲张的疗效。方法:2012年12月至2014年12月来北京医院国家老年医学中心就诊的精索静脉曲张患者35例,分为两组分别接受单孔腹腔镜下精索静脉高位结扎术和显微外科精索静脉结扎术,中位随访13个月,本研究对患者术前及术后的精液质量、两种手术方式的围手术期并发症及术后精索静脉曲张的复发率进行比较。结果:通过对比发现,治疗后两组手术患者的精液质量与治疗前相比差异均有统计学意义(均P<0.05),两组间比较精子密度差异不显著,显微外科组精子活力比单孔腹腔镜组提高更大,差异无统计学意义(P>0.05);腹腔镜组及显微镜组各发生并发症1例均为附睾炎、无复发,差异无统计学意义(P>0.05)。结论:显微外科静脉结扎术在改善患者精液质量上具有优势,已经成为目前手术治疗精索静脉曲张的"金标准",单孔腹腔镜手术创伤小,手术时间短,术后恢复快,围手术期并发症低,对精索静脉曲张患者也是一个不错的选择。

Objective： To compare the clinical efficacy of low-approach microscopic and single port laparoendoscopic varicocelectomy in the treatment of varicocele. Methods： The pre-and post-operative clinical data about 35 varicocele patients including 18 ones treated by low-approach microscopic varicocelectomy and 17 ones by single port laparoscopic varicocelectomy was studied. All the patients were followed up for 13 months. The operation time,hospital stay,pre-and post-operative sperm concentration and progressive motility,incidence of complications and rate of recurrence were compared between the two groups. Results： Difference in sperm quality between before and after treatment was significant in the two groups（ all P〈0. 05）. Difference in sperm concentration was not significant,and improvement in sperm motility in the low-approach microscopic group was better than the single port laparoendoscopic group,all without significant difference（ P〉0. 05）. There were one case of postoperative complications and no recurrence in both groups,without significant difference（ P〉0. 05）. Conclusions： Low-approach microscopic varicocelectomy is of remarkable effect in the improvement of sperm quality,which is regarded as the golden standards for the treatment of varicocele. The single port laparoendoscopic varicocelectomy has the advantages of low incidence of complications,short operation time and hospital stay and fast recovery,which is also a good choice.