显微镜下精索静脉低位结扎术治疗精索静脉曲张的效果及对性功能的影响

Effect of Low Ligation of Spermatic Vein on Varicocele under Microscope and Its Influence on Sexual Function

目的 对精索静脉曲张(Varicocele, VC)患者应用显微镜下精索静脉低位结扎术(以下简称低位结扎术),探讨其效果及对精子质量、性功能的影响。方法 回顾性选取2020年1月—2022年12月三明市第二医院收治的86例VC患者的临床资料,根据手术方案分组,对照组43例行精索高位结扎术,观察组43例行低位结扎术,比较两组患者围术期指标、精子质量、并发症、性功能。结果 观察组手术时间长于对照组,术中出血量、术后3 d疼痛视觉模拟评分、住院时间均优于对照组,差异有统计学意义(P均<0.05);术前两组患者精子总数、浓度、存活率各项指标比较,差异无统计学意义(P均>0.05),术后两组精子质量相关指标比较,观察组优于对照组,差异有统计学意义(P均<0.05);观察组术后并发症的总发生率为4.65%,较对照组的18.60%低,差异有统计学意义(χ^(2)=4.074,P<0.05);两组术前的睾酮、国际勃起等性功能评分比较,差异无统计学意义(P均>0.05),术后,观察组上述性功能评分指标均优于对照组,差异有统计学意义(P均<0.05)。结论 对VC患者而言,显微镜下精索静脉低位结扎术具有较好应用前景,既能减轻术后疼痛,加速康复,还可提高精子质量,有效提高患者性功能,减少术后并发症发生,值得临床借鉴。

Objective To investigate the effect of low ligation of spermatic vein(hereinafter referred to as low ligation)under microscope on the sperm quality and sexual function in patients with varicocele(VC).Methods Clinical data of 86 VC patients admitted to Sanming Second Hospital from January 2020 to December 2022 were retrospectively selected and grouped according to the surgical plan.The control group(43 cases)underwent high ligation and the observation group(43 cases)underwent low ligation.Perioperative indexes,sperm quality,complications and sexual function were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,the amount of blood loss during operation,the Visual Analog Scale score 3 days after operation and the length of hospital stay were better than those of the control group,the differences were statistically significant(all P<0.05).There were no statistically significant differences in total sperm count,concentration and survival rate between two groups before surgery(all P>0.05).The comparison of above sperm quality related indicators between the two groups after surgery showed that the observation group was better than the control group,and the differences were statistically significant(all P<0.05).The total incidence of postoperative complications in the observation group was 4.65%,which was lower than 18.60%in the control group,and the difference was statistically significant(χ^(2)=4.074,P<0.05).There was no statistically significant difference in preoperative testosterone and international erectile function scores between the two groups(P>0.05).After operation,the sexual function scores of the observation group were better than those of the control group, and the differences were statistically significant (P<0.05). Conclusion For VC pa tients, microscopically low spermatic vein ligation has a good application prospect, which can not only reduce postop erative pain, accelerate recovery, but also improve sperm quality, effectively improve patients' sexual function, and re duce postoperative complications, which is worthy of clinical reference.