不同手术方式治疗精索静脉曲张不育临床效果及与患者年龄的关系

Efficacy of different surgical methods for treating sterility patients with varicocele and their correlation with the age

目的:分析腹膜后高位结扎、腹腔镜及显微镜手术方案治疗精索静脉曲张不育患者效果及与患者年龄关系.方法:选择2015年1月-2019年7月在本院治疗的精索静脉曲张不育育龄(22~39岁)男性患者117例,根据手术方式不同将患者分为3组,A组采用腹膜后高位结扎手术(n=35),B组采用腹腔镜手术(n=42),C组采用显微镜手术(n=40);各组根据不同年龄段(22~30岁)分为A1(n=20)、B1(n=23)、C1(n=23),(31~40岁)A2组(n=15)、B2组(n=19)、C2组(n=17).记录患者围术期指标,分别于术前30d、术后12个月进行精液分析.结果:A组手术时间、术后住院时间均高于B、C组,住院费用、术后出血量低于B、C组,术后恢复胃肠功能时间低于B组(均P<0.05).术后12个月,各组精子活力和浓度均高于术前,精子畸形率均低于术前,C1、C2组精子活力、精子浓度高于A1、A2及B1、B2组,B1、B2组精子活力高于A1、A2组,C1、C2组精子畸形率低于A1、A2和B1、B2组(均P<0.05).各术式术后患者精液质量改善程度与年龄均无相关性,术后并发症及复发发生率均无差异(均P>0.05).2年后复查,A组配偶妊娠率高于B、C两组(P<0.05).结论:治疗精索静脉曲张不育,显微镜手术方案综合疗效最佳;术后患者精子质量改善程度与患者年龄无明显相关性.

Objective: To investigate the efficacy of retroperitoneal high ligation, laparoscopic, or microscopic surgery for treating sterility patients with varicocele, and to study their correlation with the age of the patients. Methods: 117 sterility patients with varicocele aged 22-39 years old were enrolled and were divided into three groups according to different surgical methods from January 2015 to July 2019. 35 patients in group A received retroperitoneal high ligation, 42 patients in group B received laparoscopic surgery, and 40 in group C received microscopic surgery. The patients in each group were further divided into two subgroups according to their ages, which included 20 patients with 22-39 years old in group A1, 23 patients with 22-39 years old in group B1, 23 patients with 22-39 years old in group C1, 15 patients with 31-40 years old in group A2, 19 patients with 31-40 years old in group B2, and 17 patients with 31-40 years old in group C2. The preoperative indexes of the patients in these groups were recorded. And the semen of the patients in these groups was collected in 30 days before surgery and in 12 month after surgery for analysis. Results: The operation time and the postoperative hospital stay time of the patients in group A were significantly higher than those of the patients in group B and group C, and the hospitalization cost and the postoperative blood loss of the patients in group A were significantly lower than those of the patients in group B and C. The postoperative gastrointestinal function recovery time of the patients in group A was significantly lower than that of the patients in group B(P<0.05). 12 months after surgery, the sperm motility and concentration of the patients in these groups were significantly higher than those before surgery,and the sperm malformation rate of the patients in these groups was significantly lower than that before surgery.The sperm motility and concentration of the patients in group C1and group C2were significantly higher than those of the patients in group A1,group A2,group B1,and groupB2,the sperm motility of the patients in group B1and group B2was significantly higher than that of the patients in group A1and group A2,and the sperm malformation rate of the patients in group C1and group C2was significantly lower than that of the patients in group A1,group A2,group B1,and group B2(all P<0.05).There was no significant correlation between the postoperative semen quality improvement of the patients in these groups and their age(P>0.05).There were no significant differences in the incidences of postoperative complications and recurrence of varicocele of the patients among group A,among B,and among C(P>0.05).After 2years,the pregnancy rate of the spouse of the patients in group A was significantly higher than that of the patients in group B and group C(P<0.05).Conclusion:Retroperitoneal high ligation,laparoscopic,and microscopic surgery can treat the sterility patients with varicocele,and the comprehensive curative effect of microscopic surgery has the best efficacy.There is no significant correlation between the postoperative semen quality improvement of the patients and their age.