不同手术方案对精索静脉曲张患者的精液质量、预后及安全性的影响分析

Analysis of the influence of different surgical procedures on semen quality, prognosis and safety of patients with varicocele

目的探讨不同手术方案对精索静脉曲张患者的精液质量、预后及安全性的影响。方法选取本院2015年9月至2018年12月收治的118例精索静脉曲张患者的临床资料,按手术方式分成研究组(47例)、传统组(28例)和显微镜组(43例)。传统组行传统腹腔镜术式治疗,研究组行耻骨上辅助经脐微双孔腹腔镜精索内静脉高位结扎术治疗,显微镜组行显微镜精索静脉结扎术治疗。比较三组的手术前后精液质量和仰卧位静息状态的精索静脉最大直径(DSR)、术后并发症发生情况、术后配偶1年受孕率以及手术前后卵泡刺激素(FSH)水平的差异。结果各组术后的精子密度、精子活率、正常形态精子百分率均较术前增加(均P<0.05),DSR较术前降低(P<0.05)。研究组、显微镜组的术后精子密度、精子活率均高于传统组,而DSR低于传统组,差异均有统计学意义(均P<0.05)。三组的阴囊水肿、睾丸鞘膜积液、局部神经损伤、急性附睾炎发生率比较,差异均无统计学意义(均P>0.05)。研究组、显微镜组在术后1年时的配偶受孕率均高于传统组,但差异无统计学意义(P>0.05)。三组术后的FSH水平均低于术前,且研究组、显微镜组的FSH改善程度优于传统组,差异均有统计学意义(均P<0.05)。结论耻骨上辅助经脐微双孔腹腔镜精索内静脉高位结扎术与显微镜下精索静脉结扎术在改善精液质量及预后方面优于传统手术方式,同时术后并发症较少。另外经脐手术较显微镜下结扎术切口更加隐蔽美观,值得临床推广应用。

Objective To investigate the effect of different surgical procedures on semen quality,prognosis and safety in patients with varicocele.Methods A total of 118 patients with varicocele admitted to our hospital from September 2015 to December 2018 were selected by random sampling method.According to different treatment methods,they were divided into research group(n=47),traditional group(n=28)and microscope group(n=43).The traditional group was treated with traditional laparoscopic surgery,the research group was treated with suprapubis-assisted umbilical mini-daul-site laparoscopic internal spermatic vein high ligature,and the microscope group was treated with microscope ligation of internal spermatic vein.The semen quality,resting state maximum diameter of spermatic vein(DSR)in supine position,postoperative complications,postoperative pregnancy rate of partners and follicle stimulating hormone(FSH)levels were compared between the three groups before and after surgery.Results The sperm density,sperm motility and percentage of normal sperm in each group after operation were higher than those before operation(all P<0.05),while DSR was lower than those before operation(P<0.05).There were significant differences in sperm density,sperm motility and DSR among the study group,the traditional group and the microscope group(all P<0.05).There was no significant difference in the incidence of scrotal edema,testicular hydrocele,local nerve injury and acute epididymitis among the three groups(all P>0.05).The comparison of spouse pregnancy rate 12 months after operation among the three groups showed that the study group and the microscope group were higher than the traditional group,but the difference was not statistically significant(P>0.05).The levels of FSH in the three groups were significantly improved,and the improvement degree of the study group and the microscope group was better than that of the traditional group(all P<0.05).Conclusions Suprapubis-assisted umbilical mini-daul-site laparoscopic internal spermatic vein high ligature of varicocele and microscopic ligation of varicocele can effectively improve the semen quality and prognosis of patients with varicocele with fewer postoperative complications.In addition,the incision of transumbilical surgery is more subtle and aesthetic than that of microscopical ligation,which is worthy of clinical application.