腹膜外与腹膜腔途径腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效比较

Comparison of the efficacy of laparoscopic high ligation of spermatic veins by extraperitoneal versus transperitoneal approach in the treatment of varicocele

目的对比腹膜外与腹膜腔途径腹腔镜精索静脉高位结扎术治疗精索静脉曲张(VC)的临床疗效。方法130例精索静脉曲张患者,按照就诊次序随机分为观察组(66例)和对照组(64例)。观察组采用腹膜外途径腹腔镜精索静脉高位结扎术治疗,对照组采用腹膜腔途径腹腔镜精索静脉高位结扎术治疗。比较两组患者手术时间、排气时间、起床活动时间及住院时间,并发症发生情况及复发情况,手术前及术后6个月精液质量及精索静脉内径,分析术后情况。结果两组手术时间比较,差异无统计学意义(P>0.05);观察组排气时间(5.1±2.4)h、起床活动时间(10.2±2.7)h及住院时间(2.1±1.3)d均短于对照组的(7.5±1.5)h、(12.2±2.2)h、(4.2±2.7)d,差异有统计学意义(P<0.05)。两组阴囊水肿、急性附睾炎、睾丸鞘膜积液发生率及复发率比较,差异无统计学意义(P>0.05)。手术前及术后6个月,两组精子密度、活率、畸形率及精索静脉内径组间比较,差异无统计学意义(P>0.05);术后6个月,两组精子密度、活率、畸形率及精索静脉内径均优于手术前,差异有统计学意义(P<0.05)。两组患者症状、体征全部缓解,无漏扎静脉;其中术前精液异常、婚后不育的31例患者术后6个月复查精液常规,精子密度、活率升高及畸形率下降,精液质量好转,1年后生育者12例。结论腹膜外与腹膜腔途径腹腔镜精索静脉结扎术治疗精索静脉曲张疗效同样可靠有效,但腹膜外途径腹腔镜精索静脉高位结扎术有恢复快、腹腔干扰少等优势。

Objective To compare the clinical efficacy of laparoscopic high ligation of spermatic veins by extraperitoneal versus transperitoneal approach in the treatment of varicocele(VC).Methods A total of 130 patients with varicocele were randomly divided into observation group(66 patients)and control group(64 patients)according to the order of consultation.The observation group was treated by laparoscopic high ligation of spermatic veins via extraperitoneal approach,and the control group was treated by laparoscopic high ligation of spermatic veins via transperitoneal approach.The operation time,exhaust time,off-bed activity time,hospitalization time,complication rate and recurrence,quality of semen and diameter of spermatic vein before surgery and 6 months after surgery were compared between the two groups,and the postoperative conditions were analyzed.Results There was no statistically significant difference in the operation time between the two groups(P>0.05).The exhaust time(5.1±2.4)h,off-bed activity time(10.2±2.7)h and hospitalization time(2.1±1.3)d in the observation group were all shorter than(7.5±1.5)h,(12.2±2.2)h,and(4.2±2.7)d in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the incidence and recurrence rate of scrotal edema,acute epididymitis,testicular hydrocele between the two groups(P>0.05).Before surgery and 6 months after surgery,there was no statistically significant difference in sperm density,viability rate,malformation rate and spermatic vein diameter between the two groups(P>0.05).6 months after surgery,the sperm density,viability rate,malformation rate and spermatic vein diameter of the two groups were better than those before surgery,and the difference was statistically significant(P<0.05).In both groups,all the patients’symptoms and signs were relieved,and there was no missed vein;among them,31 patients with abnormal semen before surgery and infertility after marriage had their semen routine rechecked 6 months after surgery,and the sperm density,viability and malformation rate were increased and the semen quality was improved,and 12 patients gave birth after 1 year.Conclusion Laparoscopic high ligation of spermatic veins by extraperitoneal and transperitoneal approach is equally reliable and effective in the treatment of varicocele,but laparoscopic high ligation of spermatic veins by extraperitoneal approach has the advantages of faster recovery and less abdominal interference.