显微镜下三种术式治疗精索静脉曲张疗效比较

Comparison on Clinical Effect of Three Surgical Methods under Microscope in Treatment of Varicocele

目的:探讨显微镜下精索静脉结扎不同术式治疗精索静脉曲张的效果。方法:选取147例精索静脉曲张患者作为研究对象,依据采取的术式不同将其分为Ⅰ、Ⅱ、Ⅲ组各49例。Ⅰ组行经腹股沟精索静脉高位结扎术,Ⅱ组行经腹膜后精索静脉高位结扎术,Ⅲ组行精索静脉低位结扎术。对比3组的手术相关指标以及住院时间、精子质量以及并发症和复发情况。结果:Ⅰ组手术时间(55.28±15.36)min、Ⅱ组手术时间(56.04±16.730)min,均明显短于Ⅲ组(75.29±16.97)min;3组出血量及总住院时间差异无统计学意义(P>0.05)。术后1年,3组精子密度、存活率及(A+B)级活动力精子比例较术前均显著提高,Ⅲ组精子密度[(185.36±49.37)×10~6/m L]较Ⅰ组[(149.65±38.22)×10~6/mL]和Ⅱ组[(148.77±39.62)×10~6/m L]显著升高(P<0.05),Ⅲ组存活率[(99.55±22.16)%]较Ⅰ组[(73.45±17.21)%]和Ⅱ组[(74.08±18.06)%]显著升高;Ⅲ组(A+B)级活动力精子比例[(91.79±25.68)%]较Ⅰ组[(70.25±15.16)%]和Ⅱ组[(72.83±17.58)%]显著升高。Ⅲ组术后并发症发生率为5.56%,较Ⅰ组(23.61%)和Ⅱ组(20.83%)显著降低。3组复发情况差异无统计学意义(P>0.05)。结论:显微镜下精索静脉结扎术治疗精索静脉曲张效果确切,精索静脉低位结扎术相对于经腹膜后或腹股沟精索静脉高位结扎术,更有利于提高精子质量、降低术后并发症风险。

Objective To study the effects of different methods of spermatic vein ligation in treatment of varicocele.Methods Patients with varicocele(147cases)were selected as research objects and divided into groups I,II and III according to different methods of operation,with49cases in each group.The patients in group I underwent high ligation of spermatic vein by inguinal vein,the patients in group II underwent high ligation of retroperitoneal spermatic vein,and the patients in group III underwent low ligation of spermatic vein.Then,the operative parameters,hospitalization time,sperm quality,complications and recurrence of three groups were analyzed.Results The operation time in group I[(55.28±15.36)min]and group II[(56.04±6.730)min]was significantly shorter than that of group III[(75.29±16.97)min].There was no significant difference in the amount of bleeding and total hospitalization time among three groups(P>0.05).One year after surgery,the sperm density,survival rate,and percentage of(A+B)motility in three groups were significantly higher than those before operation.The sperm density in group III[(185.36±49.37)×106/mL]was significantly higher than those in group I[(149.65±38.22)×106/mL]and group II[(148.77±39.62)×106/mL](P<0.05).The survival rate in group III[(99.55±22.16)%]was significantly higher than those in group I[(73.45±17.21)%]and group II[(74.08±18.06)%].The percentage of(A+B)motility in group III[(91.79±25.68)%]was significantly higher than those in group I[(70.25±15.16)%]and group II[(72.83±17.58)%](P<0.05).The incidence of post-operative complication in group III was5.56%,which was significantly lower than that in group I(23.61%)and group II(20.83%).There was no significant difference in the recurrence among three groups(P>0.05).Conclusion The clinical effects of three surgical methods in treatment of varicocele are definite.The low ligation of spermatic vein is better than the other two methods in improving sperm quality and reducing the risk of surgical complication.