显微结扎术治疗精索静脉曲张的效果

Observation of surgical indexes and postoperative anti-sperm antibody level in patients with varicocele treated by microligation

目的探讨显微结扎术治疗精索静脉曲张(VC)的效果。方法收集2018年1月至2020年12月于首都医科大学附属北京天坛医院接受手术治疗的VC患者临床资料,61例采用腹腔镜精索静脉高位结扎术治疗的患者作为腹腔镜组;61例采用经外环口显微镜下精索静脉结扎术治疗的患者作为显微组。比较两组患者的手术指标(手术时间、术中出血量、术后胃肠功能恢复时间、住院时间、术后切口疼痛程度)和术后并发症发生情况。比较两组患者术前、术后3个月抗精子抗体(ASA)阳性率、精子质量指标(精液量、精子浓度、向前运动精子率、精子活动率、精子存活率)、激素水平[血清睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)]和睾丸体积的变化情况。结果显微组患者的手术时间长于腹腔镜组患者,术中出血量少于腹腔镜组患者,术后胃肠功能恢复时间、住院时间短于腹腔镜组患者,术后切口视觉模拟评分法评分低于腹腔镜组患者,差异均有统计学意义(P<0.05)。显微组患者术后并发症的发生率为9.84%(6/61),低于腹腔镜组患者的26.23%(16/61),差异有统计学意义(P=0.019)。术后3个月,显微组患者的ASA阳性率低于腹腔镜组,精液量、精子浓度、向前运动精子率、精子活动率、精子存活率均高于腹腔镜组患者,差异均有统计学意义(P<0.05)。术后3个月,显微组患者的T水平高于腹腔镜组,FSH、LH水平均低于腹腔镜组,差异均有统计学意义(P<0.01)。术后3个月,两组患者的左侧、右侧睾丸体积均大于本组术前,差异均有统计学意义(P<0.05)。结论显微结扎术治疗精索静脉曲张的各项手术指标更为理想,术后ASA阳性率低,可更有效的改善精子质量。

Objective To investigate the effect of microligation in the treatment of varicocele(VC).Method The clinical data of VC patients who underwent surgery in Beijing Tiantan Hospital,Capital Medical University from January 2018 to December 2020 were collected.Sixty-one patients treated with laparoscopic high ligation of spermatic vein were selected as the laparoscopic group,and 61 patients treated with external ring mouth microscopical ligation of spermatic vein were selected as the microscopic group.The operation indexes(operation time,intraoperative bleeding,postoperative gastrointestinal function recovery time,hospital stay,postoperative incision pain)and postoperative complications were compared between the two groups.The changes of antisperm antibody(ASA)positive rate,sperm quality indexes(semen volume,sperm concentration,forward motile sperm rate,sperm motility rate,sperm survival rate),hormone level[serum testosterone(T),follicle stimulating hormone(FSH),luteinizing hormone(LH)]and testicular volume were compared between the two groups before and 3 months after operation.Result The operation time of patients in the microscope group was longer than that in the laparoscopy group,the amount of intraoperative bleeding was less than that in the laparoscopy group,the postoperative gastrointestinal function recovery time and hospital stay were shorter than those in the laparoscopy group,and the postoperative incision visual analogue scale score was lower than that in the laparoscopy group(P<0.05).The incidence of postoperative complications in the microscopic group was 9.84%(6/61),which was lower than 26.23%(16/61)in the laparoscopic group(P=0.019).Three months after operation,the ASA positive rate in the microscopical group was lower than that in the laparoscopic group,and the semen volume,sperm concentration,forward motility,sperm motility and sperm survival rate were higher than those in the laparoscopic group(P<0.05).Three months after operation,the T level of patients in the microscope group was higher than that in the laparoscopy group,and the levels of FSH and LH were lower than those in the laparoscopy group(P<0.01).Three months after operation,the left and right testicular volumes of the two groups were significantly higher than those before operation(P<0.05).Conclusion Microligation is more ideal in the treatment of varicocele.The positive rate of antisperm antibody is low,which can more effectively improve the quality of sperm.