精索静脉曲张青年患者采用不同手术干预后的精液质量比较

Comparison of semen quality after different surgical interventions for varicocele in young patients

目的探讨青年精索静脉曲张患者采用不同手术干预对精液质量的影响。方法选取2018年4月至2020年4月杭州市余杭区第三人民医院手术治疗的171例精索静脉曲张患者的临床资料进行回顾性分析。依据手术方式不同将患者分为开放组(n=42)、腹腔镜组(n=45)、显微镜组(n=44)、介入栓塞组(n=40)。开放组行传统开放精索静脉结扎术,腹腔镜组行腹腔镜下精索静脉高位结扎术,显微镜组行显微镜下精索静脉结扎术,介入栓塞组行介入栓塞术。对比四组围术期相关指标及术后并发症发生率、复发率,检测并对比四组手术前后精液质量(精子密度、精子存活率、精子畸形率)。结果四组手术时间比较,介入栓塞组>显微镜组>腹腔镜组>开放组(P<0.05);四组住院时间比较,开放组>腹腔镜组、显微镜组>介入栓塞组(P<0.05)。四组术后精子密度、精子存活率显著高于术前,而精子畸形率显著低于术前(P<0.05);显微镜组术后精子密度、精子存活率显著高于开放组、腹腔镜组、介入栓塞组,而精子畸形率显著低于开放组、腹腔镜组、介入栓塞组(P<0.05)。腹腔镜组、显微镜组术后并发症发生率及复发率显著低于开放组、介入栓塞组(P<0.05)。结论显微镜下精索静脉结扎术治疗青年精索静脉曲张能够更好地改善患者精液质量,且术后并发症发生率、复发率较低。

Objective To investigate the effect of different surgical intervention on semen quality in young patients with varicocele. Methods The clinical data of 171 patients with varicocele treated by the Third People′s Hospital of Yuhang District of Hangzhou from April 2018 to April 2020 were analyzed retrospectively and divided into open group(n=42), laparoscopic group(n=45), microscope group(n=44) and interventional embolization group(n=40) according to different surgical methods. The open group received traditional open spermatic vein ligation, the laparoscopic group received high spermatic vein ligation, the microscope group received microscopic spermatic vein ligation, and the interventional embolization group received interventional embolization. The perioperative indicators, postoperative complications and recurrence rates of the four groups were compared, and the semen quality(sperm density, sperm survival rate and sperm malformation rate) before and after the operation of the four groups were detected and compared. Results Comparison of operation time among the four groups: interventional embolization group > microscope group > laparoscopic group > open group(P<0.05);The length of hospital stay in the four groups: the open group > the laparoscopic group, the microscope group > the interventional embolization group(P<0.05). The sperm density and sperm survival rate in four groups were significantly higher after operation than before operation, while the sperm malformation rate was significantly lower than before operation(P<0.05). The sperm density and sperm survival rate in the microscope group were significantly higher than those in the open group, laparoscopic group and interventional embolization group, while the sperm malformation rate was significantly lower than that in the open group, laparoscopic group and interventional embolization group(P<0.05). The incidence and recurrence rate of postoperative complications in laparoscopic group and microscope group were significantly lower than those in open group and interventional embolization group(P<0.05). Conclusions Microscopical varicocele ligation in the treatment of young varicocele can better improve the semen quality, and the incidence of postoperative complications and recurrence is low.