MSV与HLOISV治疗精索静脉曲张患者的效果比较

Comparison of effects of microscopic subinguinal varicocele ligation and retroperitoneal high ligation of internal spermatic vein in treatment of patients with varicocele

目的:比较显微镜下外环下精索静脉结扎术(MSV)与经腹膜后精索内静脉高位结扎术(HLOISV)治疗精索静脉曲张(VC)患者的效果。方法:回顾性分析2021年7月至2022年7月该院收治的154例VC患者的临床资料,按照手术方法不同将其分为观察组和对照组各77例。对照组行HLOISV治疗,观察组行MSV治疗,术后两组均随访3个月。比较两组手术相关指标(手术时间、住院时间、术中出血量)水平,术前和术后3、7 d阴囊疼痛程度[视觉模拟评分法(VAS)]评分,术前和术后1、3个月精液质量指标(精子畸形率、精子活力、精子密度)水平、性激素指标[睾酮、黄体生成素(LH)、卵泡刺激素(FSH)]水平,以及并发症发生率。结果:观察组术中出血量少于对照组,住院时间短于对照组,手术时间长于对照组,差异有统计学意义(P<0.05);术后3、7 d,观察组阴囊VAS评分均低于对照组,差异有统计学意义(P<0.05);术后1、3个月,观察组精子畸形率均低于对照组,精子活力均高于对照组,精子密度均大于对照组,差异有统计学意义(P<0.05);术后1、3个月,观察组睾酮水平均高于对照组,LH、FSH水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为3.90%(3/77),低于对照组的15.58%(12/77),差异有统计学意义(P<0.05)。结论:MSV治疗VC患者可减少术中出血量,缩短住院时间,降低阴囊疼痛评分和并发症发生率,改善性激素指标水平,提高精液质量,效果优于HLOISV治疗,但需延长手术时间。

Objective:To compare effects of microscopic subinguinal varicocele ligation(MSV)and retroperitoneal high ligation of internal spermatic vein(HLOISV)in treatment of patients with varicocele(VC).Methods:The clinical data of 154 patients with VC admitted to this hospital from July 2021 to July 2022 were retrospectively analyzed.According to different surgical methods,they were divided into observation group and control group,77 cases in each.The control group was treated with HLOISV,while the observation group was treated with MSV.Both groups were followed up for 3 months.The operation-related index levels(operation time,hospitalization time,intraoperative blood loss),the degree of scrotal pain[visual analogue scale(VAS)]before and 3 and 7 days after the surgery,the semen quality index levels(sperm deformity rate,sperm motility,sperm density)before and 1 and 3 months after the surgery,the sex hormone index levels[testosterone,luteinizing hormone(LH),follicle stimulating hormone(FSH)],and the incidence of complications were compared between the two groups.Results:The intraoperative blood loss in the observation group was less than that in the control group,the hospitalization time was shorter than that in the control group,the operation time was longer than that in the control group,and the differences were statistically significant(P<0.05).3 and 7 days after the surgery,the scrotum VAS scores in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).1 and 3 months after the surgery,the sperm deformity rates of the observation group were lower than those of the control group,the sperm motility was higher than that of the control group,the sperm density was higher than that of the control group,and the differences were statistically significant(P<0.05).1 and 3 months after the surgery,the level of testosterone in the observation group was higher than that in the control group,the levels of LH and FSH were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the observation group was 3.90%(3/77),which was lower than 15.58%(12/77)in the control group,and the difference was statistically significant(P<0.05).Conclusions:MSV in the treatment of the VC patients can reduce the intraoperative blood loss,shorten the hospitalization time,reduce the scrotal pain scores and the incidence of complications,improve the sex hormone levels,and improve the semen quality.Moreover,it is superior to HLOISV treatment,but the operation time needs to be prolonged.