经腹股沟途径和高位腹膜后途径显微外科精索静脉高位结扎方法的比较

Comparison of high ligation methods of spermatic veins in microsurgery between inguinal and retroperitoneal approaches

目的:比较经腹股沟途径和高位腹膜后途径显微外科精索静脉高位结扎方法的优缺点。方法:226例精索静脉曲张患者随机分为两组,A组采用经腹股沟途径(n=119例),B组采用经高位腹膜后途径(n=107)。分析比较两组手术时间、术后效果、并发症及精液改善情况及配偶自然怀孕率等指标。结果:A组手术切口长度明显短于B组[(2.0±0.35)cm vs.(2.5±1.69)cm,P<0.05];A组手术时间少于B组,但差异无统计学意义[(30.2±4.8)min vs.(35.6±8.2)min,P>0.05)];A组平均结扎静脉数明显大于B组[(7.2±3.3)支vs.(2.8±0.9)支,P<0.05]。A组术中所见淋巴管支数明显大于B组[(2.5±1.3)支vs.(1.5±0.3)支,P<0.05]。两组患者术后均无睾丸鞘膜积液、睾丸萎缩等。与术前相比,两组术后精液有明显改善(P<0.05),两组间精液改善比较差异无统计学意义(P>0.05)。两组各有2例复发,复发率比较差异无统计学意义(P>0.05)。A组配偶有63例怀孕;B组配偶有50例怀孕,两组配偶自然怀孕率比较差异无统计学意义(P>0.05)。结论:显微外科经腹股沟和腹膜后2种途径精索静脉高位结扎术均安全有效,但经腹股沟途径切口更易显露,适应于所有患者,对较瘦体型者及有腹股沟区手术史的患者可以选用高位腹膜后途径。

Objective: To compare two micro-varicocelectomy methods, investigate the best method of operation. Method: Two hundred and twenty-six patients were divided into two groups: A: inguinal approach;B: high retroperitoneal approach. Their operative time, number of vein, number of lymphatics, number of artery. side effects, results after operation, spouse partner rate of pregnancy were compared. Result: Length of incision: group A(2.0±0.35) cm, group B(2.5±1.69) cm, P<0.05. Operation time: group A(30.2±4.8) min, group B(35.6±8.2) min, no difference. Vein ligation during operation: group A: mean(7.2±3.3) branches;group B: mean(2.8±0.9) branches, P<0.05. Lymphatics observed: group A: mean(2.5±1.3) branches;group B: mean(1.5±0.3) branches, P<0.05. Recurrent rate: detected by color Doppler sound, group A: 2 cases;group B: 2 cases, no difference. Natural pregnancy group A: 63 cases;group B: 50 cases, no difference. No testis atrophy was found in both groups. Conclusion: Two methods of microsurgery varicocelectomy are safe and effective for the treatment of varicocele. Inguinal method is suitable to all patients owing to good exposure of spermatic cord. High abdominal approach might be used to thin or second operation patients.