不同手术方式治疗单侧原发性精索静脉曲张的疗效

Outcome of different surgical methods on unilateral primary varicocele

目的比较采用显微镜下精索静脉结扎术、腹腔镜下精索静脉高位结扎术、精索静脉高位结扎术治疗单侧原发性精索静脉曲张的临床疗效,为其临床诊疗提供参考。方法回顾性分析212例单侧原发性精索静脉曲张患者的临床资料,其中采用显微镜下精索静脉结扎术治疗者48例(显微镜组),采用腹腔镜下精索静脉高位结扎术治疗者74例(腹腔镜组),采用精索静脉高位结扎术治疗者90例(开放组)。比较患者手术时间、术中出血量、胃肠功能恢复时间、术后住院时间、手术前后精液质量参数及差值、复发率及术后并发症发生率。结果显微镜组手术时间长于腹腔镜组和开放组,术后住院时间短于腹腔镜组和开放组,差异均有统计学意义(P<0.05)。显微镜组术中出血量小于开放组,差异有统计学意义(P<0.05)。术后6个月,3组患者精液质量参数(精液浓度、前向运动精子率、正常形态精子率)均较术前明显升高,差异有统计学意义(P<0.05)。显微镜组手术前后精液浓度差和前向运动精子率差均高于腹腔镜组和开放组(P<0.05)。3组胃肠功能恢复时间、手术前后正常形态精子率差、复发率及术后并发症总发生率比较,差异均无统计学意义(P>0.05)。结论显微镜下精索静脉结扎术能缩短术后住院时间,改善精液质量,是治疗单侧原发性精索静脉曲张较为理想的术式。

Objective To compare the outcome of microsurgical varicocelectomy,laparoscopic high ligation of spermatic vein and high ligation of spermatic vein on unilateral primary varicocele,and provide basis for the clinical diagnosis and treatment of the disease.MethodsThe clinical data of 212 patients with unilateral primary varicocele were retrospectively analyzed.Of which 48 cases were treated with microsurgical subinguinal varicocelectomy(microscope group),74 cases were treated with high ligation of spermatic vein under laparoscopy(laparoscopy group)and 90 cases were treated with high ligation of spermatic vein(open group).The operation time,intraoperative blood loss,recovery time of gastrointestinal function,postoperative hospital stay,the quality parameters and difference of semen before and after operation,recurrence rate and incidence of postoperative complications were compared.Results Operation time of the microscope group was longer than that of the laparoscopy group and the open group,and postoperative hospital stay of the microscope group was shorter than that of the laparoscopy group and the open group,the differences were statistically significant(P<0.05).The intraoperative blood loss of the microscope group was less than that of the open group,the difference was statistically significant(P<0.05).The quality parameters of semen(including sperm concentration,rate of sperm with forward movement and sperm normality rate)among the 3 groups 6 months after operation were higher than those before operation,the differences were statistically significant(P<0.05).The differences of sperm concentration and rate of sperm with forward movement before and after operation in the microscope group were higher than those in the laparoscopy group and the open group(P<0.05).There was no significant difference in recovery time of gastrointestinal function,the difference of sperm normality rate before and after operation,recurrence rate or incidence of total postoperative complications among the 3 groups(P>0.05).Conclusion Microsurgical varicocelectomy can shorten the postoperative hospital stay and improve the semen quality,which is an ideal surgical method for the treatment of unilateral primary varicocele.