腹腔镜下精索静脉高位结扎与显微镜下低位结扎的治疗效果及对患者血流动力学的影响

Effect of low-approach microsurgical varicocelectomy and high-approach laparoscopic varicocelectomy and the influence on hemodynamics

目的观察腹腔镜下精索静脉高位结扎与显微镜下低位结扎的治疗效果及对患者血流动力学、精液质量的影响。方法将104例患者随机分为对照组和观察组,每组52例。对照组进行腹腔镜下高位结扎,观察组进行显微镜下低位结扎。比较2组手术时间、术后住院时间、术后6个月并发症发生率和复发率,比较术前和术后6个月睾丸动脉血流动力学参数和精液质量。结果观察组手术时间显著长于对照组,住院时间显著短于对照组(P<0.05);术后6个月,2组收缩期峰值流速(peak systo lic velocity,PSV)、阻力指数(resistance index,RI)及搏动指数(pulse index,PI)均较术前显著下降(P<0.05),观察组术后6个月PSV、PI和PI均低于对照组(P<0.05);术后6个月,2组精子数、精子浓度、精子活率均显著升高(P<0.05),术后6个月观察组精子数、精子浓度、精子活率均显著高于对照组(P<0.05);观察组术后并发症发生率及复发率均显著低于对照组。结论显微镜下低位结扎能有治疗精索静脉曲张,减轻并发症发生率及复发率,减轻睾丸血流阻力,改善血流动力学,提高精液质量,值得临床推广。

Objective To analyze the effect of low-approach microsurgical varicocelectomy and high-approach laparoscopic varicocelectomy and the influence on hemodynamics and semen quality.Methods One hundred and four varicocele patients were randomly divided into control group and observation group,52 cases in each group.The control group was treated with high-approach laparoscopic varicocelectomy,the observation group was treated with low-approach microsurgical varicocelectomy.The time of operation,the time of hospitalization after operation,the incidence of complications and the rate of recurrence of two groups were compared.The hemodynamic parameters of the testicular arteries and semen quality before and 6 months after the operation between two groups were compared.Results The operation time of observation group was significantly longer than control group,the time of hospitalization after operation was significantly lower than control group(P<0.05).The resistance index(RI),pulse index(PI),and peak systo lic velocity(PSV)of both groups were decreased and that of observation group were significantly lower than control group 6 months after operation(P<0.05).The number of sperm,sperm concentration and sperm motility of the two groups were significantly increased 6 months after operation(P<0.05),and that of the observation group was significantly higher than the control group(P<0.05).The incidence of complications and the rate of recurrence of observation group were significantly lower than control group.Conclusion Low-approach microsurgical varicocelectomy can effectively treat varicocele,reduce the incidence of complications and recurrence,reduce the resistance of the testicular blood flow,improve the hemodynamics and improve the quality of the semen.It is safe and worthy of clinical promotion.