精索静脉曲张腹腔镜或显微镜下精索内静脉高位结扎术对患者精液质量影响

Effects of high ligation of the spermatic vein under microscope or laparoscopy of patients with varicocele on their semen quality

目的:探讨腹腔镜或显微镜下精索内静脉高位结扎术治疗精索静脉曲张疗效及对患者精液质量的影响。方法:选取2018年6月-2020年6月本院收治的120例精索静脉曲张症患者,随机数字表法分为两组各60例,分别显微镜下(显微镜组)或腹腔镜下(腹腔镜组)精索内静脉高位结扎术,比较两组手术指标、临床疗效及术后患者精液质量变化。结果:显微镜组手术时间(2.1±0.4h)大于腹腔镜组(1.6±0.3h),排气时间(24.6±3.7h)、住院时间(5.1±0.6d)小于腹腔镜组(33.6±4.2h、6.5±1.0d)(P<0.05);术后1年,两组精液质量指标、血清睾酮水平均提高,血清卵泡刺激素、黄体生素素水平均下降且显微镜组变化幅度优于腹腔镜组,显微镜组自然妊娠率(46.7%)大于腹腔镜组(23.3%),总复发率(10.0%)和总并发症发生率(8.3%)低于腹腔镜组(25.0%、23.3%)(均P<0.05)。结论:与腹腔镜下结扎术相比,显微镜下结扎术疗效更佳、并发症更少,但操作难度较高,临床可根据患者和医院实际情况选择合适术式。

Objective: To analysis the effect of high ligation of the spermatic vein under microscope or laparoscopy of the patients with varicocele on their semen quality. Methods: 120 patients with varicocele who underwent surgical treatment were selected and were randomly divided into group A(60 cases with the spermatic vein under microscope) and group B(60 cases with the spermatic vein under laparoscopy) according to the random number table method from June 2018 to June 2020. The operative indictors, the clinical efficacy, and the sperm quality of the patients were compared between the two groups. Results: The operation time of the patients in group A(2.1±0.4 h) was significantly higher than that(1.6±0.3 h) of the patients in group B, the exhaust time(24.6±3.7 h) and the hospital stay(5.1±0.6 d) of the patients in group A were significantly lower than those(33.6±4.2 h and 6.5±1.0 d) of the patients in group B(P<0.05). One year after operation, the semen quality indexes, and the serum testosterone levels of the patients in both groups had increased significantly, but the serum follicle stimulating hormone(FSH) and luteinizing hormone levels of the patients in both groups had decreased in both groups, and the change ranges of which of the patients in group A was significantly better than that of the patients in group B. The natural pregnancy rate(46.7%) of the patients in group A was significantly higher than that(23.3%) of the patients in group B. The total recurrence rate of varicocele(10.0%) and the total complication rate(8.3%) of the patients in group A were significantly lower than those(25.0% and 23.3%) of the patients in group B(all P<0.05). Conclusion: Compared with those of laparoscopic high ligation of internal spermatic vein, the microscopic ligation of internal spermatic vein for treating the patients with varicocele has better curative effect, less complication and recurrence rate, while its operational difficulty is higher, so appropriate surgical procedures should be chosen according to the needs of the patients and the actual situation of the hospital.