显微镜下经腹股沟精索静脉高位结扎术治疗精索静脉曲张患者的短期随访研究

A Short-term Follow-up Study of Patients with Varicocele Treated with High Ligation of the Varicocele under the Microscope

目的:探究显微镜下经腹股沟精索静脉高位结扎术治疗精索静脉曲张(VC)患者的短期随访效果。方法:选取2018年7月—2020年1月荥阳市人民医院收治的92例VC患者,按照随机数表法分为Ⅰ组和Ⅱ组,每组各46例。Ⅰ组行显微镜下经腹股沟精索静脉高位结扎术,Ⅱ组行Palomo精索静脉结扎。对比两组患者术前、术后3个月和术后6个月精子浓度与总活力、睾丸动脉、包膜动脉收缩期最大血流速度(Vmax)、舒张期最小血流速度(Vmin)、平均血流速度(Vmean)、术后睾丸疼痛缓解率、阴囊水肿发生率和睾丸萎缩发生率,以及术后3个月、6个月配偶妊娠率、术后6个月复发率。结果:术后3个月、术后6个月Ⅰ组精子浓度与总活力高于Ⅱ组,差异有统计学意义(t=4.084、4.944、3.328、5.342,P<0.05);两组患者术后3个月、术后6个月睾丸动脉与包膜动脉睾丸动脉与包膜动脉、Vmin、Vmean比较,差异无统计学意义(t=0.511、0.396、0.368、0.093,P>0.05);Ⅰ组睾丸疼痛缓解率高于Ⅱ组,阴囊水肿、睾丸萎缩发生率低于Ⅱ组,差异有统计学意义(χ^(2)=5.060、4.434、4.457,P<0.05);Ⅰ组术后3个月、6个月配偶妊娠率高于Ⅱ组,差异有统计学意义(χ^(2)=4.420、6.718,P<0.05);两组术后6个月复发率差异无统计学意义(P>0.05)。结论:显微镜下经腹股沟精索静脉高位结扎术治疗VC患者,可减少睾丸萎缩、阴囊水肿、睾丸疼痛,改善精液质量,提高配偶妊娠率,且未增加术后复发风险。

Objective:To explore the short-term follow-up effect of high ligation of the inguinal spermatic vein under the microscope for the treatment of varicocele(VC)patients.Methods:A total of 92 VC patients admitted to the hospital from July 2018 to January 2020 were selected and randomly divided into groups,with 46 cases in each group.Group Ⅰ underwent high ligation of the spermatic vein under the microscope,and group Ⅱ underwent Palomo spermatic vein ligation.The sperm concentration and total motility,testicular artery and capsular artery systolic maximum blood flow velocity(Vmax),diastolic minimum blood flow velocity(Vmin),Mean blood flow velocity(Vmean),postoperative testicular pain relief rate,incidence of scrotal edema and testicular atrophy,as well as spouse pregnancy rate at 3 and 6 months after operation,and recurrence rate at 6 months after operation were compared between the two groups.Results:The sperm concentration and total motility of group Ⅰ were higher than those of groupⅡat 3 months and 6 months after operation,the difference was statistically significant difference(t=4.084,4.944,3.328,5.342,P<0.05).There was no significant difference in testicular artery and capsular artery,testicular artery and capsular artery,Vmin and Vmean between the two groups at 3 months and 6 months after operation(t=0.511,0.396,0.368,0.093,P>0.05).The remission rate of testicular pain in group Ⅰ was higher than that in group Ⅱ,and the incidence of scrotal edema and testicular atrophy was lower than that in group Ⅱ,the difference was statistically significant difference(χ^(2)=5.060,4.434,4.457,P<0.05).The spouse pregnancy rate in group Ⅰ was higher than that in group Ⅱ at 3 and 6 months after operation,the difference was statistically significant difference(χ^(2)=4.420,6.718,P<0.05).There was no statistically significant difference in the recurrence rate at 6 months between the two groups(P>0.05).Conclusion:Microscopic inguinal high ligation of the spermatic vein in the treatment of VC patients can reduce testicular atrophy,scrotal edema,and testicular pain,improve semen quality,and increase the pregnancy rate of spouses without increasing the risk of postoperative recurrence.