3种手术方式治疗成人精索静脉曲张疗效比较

Comparison of therapeutic effects of three surgical approaches to the treatment of adult varicocele

目的比较3种手术方式治疗成人精索静脉曲张的疗效。方法回顾性分析2015年1月至2017年1月共计24个月南方医院泌尿外科手术治疗124例成人精索静脉曲张患者临床资料,其中经腹膜后组(A组)66例,显微镜下手术治疗组(B组)33例,腹腔镜下治疗组(C组)25例;随访比较3种手术患者阴囊不适缓解率、并发症及精液质量改善情况。结果 3组比较B组手术时间最长(P <0.05),3组出血量均较少(P> 0.05)。A、B、C组患者术后阴囊坠胀缓解率分别为81.5%(22/27)、92.3%(12/13)、77.0%(10/13),阴囊疼痛缓解率分别为84.2%(32/38)、90.1%(10/11)、83.3%(10/12),3组患者阴囊不适改善情况差异无统计学意义(P> 0.05);患者术后鞘膜积液发生率分别为7.6%(5/66)、0%(0/33)、4.0%(1/25);睾丸萎缩率分别为3.0%(1/66)、0%(0/33)、4.0%(1/25);复发/持续存在率分别为13.6%(9/66)、6.1%(2/33)、16.0%(4/25)。其中B组无一例患者术后出现鞘膜积液和睾丸萎缩,术后复发率最低;但组间比较鞘膜积液率及睾丸萎缩率差异无统计学意义(P> 0.05)。3组患者术后精子密度、活率、畸形率均有改善;其中B组精液质量改善最佳(P <0.05)。结论显微镜下低位精索静脉结扎术对提高精液质量及缓解阴囊不适较其他两组明显;复发率较低,并发症较少。

Objective To compare the treatment efficacies of three different surgical managements for adult varicocele.Methods Data of 124 cases admitted for varicocele in Nanfang Hospital from January 2015 to January 2017 was analyzed retrospectively.Patients were divided into three groups:group A(palomo operation,66 cases),group B(microscopic varicocelectomy,33 cases)and group C(laparoscopic varicocelectomy,25 cases).The information of scrotal pain relief rate,complications and sperm quality improvement was collected.Results Bleeding volume was little in three groups,but much longer operation time was observed in group B(P<0.05).Testicular discomfort remission rate of group A,group B and group C was 81.5%(22/27),92.3%(12/13)and 77.0%(10/13),respectively.Postoperative scrotal pain relief rate was 84.2%(32/38),90.1%(10/11)and 83.3%(10/12),respectively,with no significant differences.The incidence of postoperative hydrocele in group A,group B and group C was 7.6%(5/66),0%(0/33)and 4.0%(1/25),respectively.Testicular atrophy rate was 3.0%(1/66),0%(0/33)and 4.0%(1/25),respectively.Recurrence rate was 13.6%(9/66),6.1%(2/33)and 16.0%(4/25),respectively.No one patient in group B complicated with postoperative hydrocele and testicular atrophy,and the postoperative recurrence rate was much lower.However,there was no significant difference in the rate of hydrocephalus and testicular atrophy between the two groups.The postoperative sperm count,motile and nor?mal morphology rate were improved in the three groups.The sperm parameters improvement under the microscope was more obvious than that in the other two groups(P<0.05).Conclusions Compared with patients in other two groups,patients in group B acquired better scrotal discomfort relief rate and the improvement in sperm parameters,with much lower recurrence rate and complications.