经腹股沟入路与腹股沟外环下切口入路显微精索静脉结扎术治疗青少年精索静脉曲张的有效性和安全性比较

Comparison of the efficacy and safety of inguinal and subinguinal approaches for microsurgical varicocelectomy in the treatment of adolescent varicocele

目的比较经腹股沟与腹股沟外环下切口两种手术入路的显微精索静脉结扎术治疗合并睾丸继发性萎缩的青少年精索静脉曲张术后睾丸追赶性生长情况、疗效及安全性。方法纳入2014年9月—2021年6月在四川省会理市人民医院泌尿外科行显微手术治疗的121例合并睾丸继发性萎缩的青少年精索静脉曲张患者,其中40例采用经腹股沟切口入路治疗,81例采用经腹股沟外环下切口入路治疗。比较两组患者的手术情况、疗效、手术并发症及预后。结果腹股沟切口入路组的显微镜使用时间显著短于腹股沟外环下切口入路组(P=0.006)。腹股沟切口入路组术中保留精索内动脉的数目少于腹股沟外环下切口入路组(P<0.001),保留精索内动脉的直径显著大于腹股沟外环下切口入路组(P=0.005)。相较于腹股沟切口入路组,腹股沟外环下切口入路组需结扎更多的精索内静脉,且直径4 mm以上的精索内静脉数目明显更多(P<0.001)。两组患者术后均未出现复发,且阴囊水肿和鞘膜积液的发生率也非常低,组间比较差异无统计学意义(P>0.05)。术后2年随访两组患者双侧睾丸体积均显著大于术前(P<0.05),且两组间及同组双侧睾丸间体积比较差异均无统计学意义(P>0.05)。结论对于合并睾丸继发性萎缩的青少年精索静脉曲张患者,相较于经腹股沟外环下切口入路,经腹股沟切口入路完成显微精索静脉结扎术手术难度明显降低,具有良好的疗效和安全性,值得临床推广应用。

Objective To compare the degree,efficacy and safety of testicular catch-up growth after inguinal and subinguinal surgery for adolescent varicocele.Methods Clinical data of 121 adolescent varicocele patients with secondary testicular atrophy treated during Sep.2014 and Jun.2021 at Huili People s Hospital were retrospectively analyzed,including 40 cases treated with the inguinal incision approach,and 81 with the subinguinal approach.The characteristics of intraoperative,efficacy,surgical complications and prognosis were compared between the two groups.Results The inguinal group had significantly shorter microscope usage time(P=0.006),fewer number of preserved internal spermatic arteries(P<0.001),and significantly larger diameter of preserved internal spermatic arteries than the subinguinal group(P=0.005).The subinguinal group required ligation of more internal spermatic veins,and there were significantly more internal spermatic veins with a diameter of 4 mm or more(P<0.001).No recurrence occurred,and the incidences of scrotal edema and hydrocele were very low(P>0.05).Two years after surgery,the bilateral testicular volume of both groups was significantly larger than that before surgery(P<0.05),and there was no significant difference in the testicles(P>0.05).Conclusion In the treatment of adolescent varicocele patients with secondary testicular atrophy,the subinguinal approach significantly reduces the difficulty of microsurgical varicocele ligation,and has good efficacy and safety,which is worthy of clinical promotion and application.