显微镜和开放精索静脉结扎手术的疗效比较

Comparison of the effects between microscopic and open ligation of spermatic vein

目的比较显微镜和开放精索静脉结扎手术的临床疗效。方法选取两院2015年1月~2017年1月择期精索静脉结扎术的原发性精索静脉曲张(VC)患者94例作为研究对象,采用随机数组表法分为显微镜组和开放组,每组各47例。比较两组手术情况、手术前后精液质量,统计两组术后并发症发生率及复发率。结果显微镜组手术时间长于开放组,切口疼痛VAS评分、住院时间、住院费用低于开放组,差异有统计学意义(P<0.05),两组动脉保留率比较,差异无统计学意义(P>0.05);显微镜组术后6个月精液浓度、精子活动率、前向运动显著高于开放组,差异有统计学意义(P<0.05);显微镜组术后6个月促卵泡激素(FSH)、黄体生成素(LH)显著低于开放组,睾酮(T)水平显著高于开放组,差异有统计学意义(P<0.05);显微镜组术后3个月并发症发生率和复发率分别为2.13%、0低于开放组的19.15%、8.51%,差异有统计学意义(P<0.05)。两组患者配偶1年受孕成功率比较,差异无统计学意义(P>0.05)。结论显微镜下精索静脉结扎手术治疗VC可显著改善精液质量,降低术后并发症发生率和复发率,缩短住院时间。

Objective To investigate and compare the effects of microscopic and open ligation of spermatic vein.Methods A total of 94 patients with primary varicocele(VC)undergone elective ligation of spermatic vein in the hospital during the period from January 2015 to January 2017 were selected as study subjects.They were divided into the microscopic group and open group by the random number table method,47 cases in each group.The conditions of surgery and semen quality before and after surgery were compared between the two groups.The incidence of postoperative complications and recurrence rate were calculated.Results The surgical time of the microscopic group was longer than that of the open group.The VAS score of incision pain,length of stay and hospitalization costs were lower/shorter/less than those of the open group(P<0.05).There was no significant difference in the arterial retention rate between the two groups(P>0.05).The semen density,sperm motility rate and forward movement in the microscopic group at 6 months after surgery were significantly higher than those in the open group(P<0.05).Levels of follicle-stimulating hormone(FSH)and luteinizing hormone(LH)in the microscopic group at 6 months after operation were significantly lower than those in the open group,while testosterone(T)levels were significantly higher than those in the open group(P<0.05).The incidence of complications and recurrence rate in the microscopic group(2.13%and 0)in 3 months after surgery were lower than those in the open group(19.15%and 8.51%)(P<0.05).There was no significant difference in the 1-year successful conception rate of spouses between the two groups(P>0.05).Conclusion The application of microscopic ligation of spermatic vein in the treatment of VC can significantly improve the semen quality,decrease postoperative complications and recurrence rate,and shorten hospital stay.