高选择性腹腔镜精索内静脉结扎术治疗精索静脉曲张的疗效研究

Efficacy of high selective laparoscopic ligation of spermatic vein for the treatment of varicocele

目的:评价高选择性腹腔镜精索静脉高位结扎术在精索静脉曲张患者治疗中的临床疗效和安全性,并与腹腔镜精索血管集束结扎术进行比较。方法:回顾性分析2011年7月~2013年6月期间共60例Ⅱ度以上精索静脉曲张患者。按手术方法式分为两组,其中,高选择性腹腔镜精索静脉高位结扎术30例(A组),腹腔镜精索血管集束结扎术30例(B组),统计学分析两组手术时间、术后并发症、术后精液质量改善等情况。结果:60例手术均成功,术后随访6个月。A组、B组手术时间分别为(41.3±9.8)min、(25.7±8.1)min;共出现手术并发症5例,其中A组发生1例阴囊水肿(3.3%,1/30),B组发生1例附睾炎、3例阴囊水肿(13.3%,4/30),术后并发症的发生率两组间差异具有统计学意义(P【0.05)。两组间精索静脉曲张复发率分别为6.7%(2/30)和3.3%(1/30),两组间差异无统计学意义(P】0.05)。术后6个月复查精液质量改善率,A、B组分别为73.3%(22/30)和60%(18/30),两组间差异具有统计学意义(P【0.05)。结论:与腹腔镜精索血管集束结扎术相比,高选择性的精索静脉高位结扎术疗效好,术后并发症发生率低,是值得推广的安全有效的手术方式。

Objective:To evaluate the clinical efficacy and safety of high selective laparoscopic ligation of sper-matic vein for the treatment of varicocele.Methods:A retrospective analysis was performed on totally 60 cases of primary varicocele above grade Ⅱ in our hospital.Group A (n =30)underwent high selective laparoscopic ligation of spermatic vein,while spermatic arteries were preserved.Group B (n =30)underwent laparoscopic cluster ligation of spermatic vein.The operation time,postoperative complications,recurrence rate,and sperm quality improvement were analyzed statistically.Results:All 60 cases operated successfully,and were followed up for 6 months after op-eration.The operation time of two groups was (41.3±9.8)min and (25.7±8.1)min respectively.The incidence of postoperative complications in two groups was 3.3% (1/30)and 13.3% (4/30)respectively.The improvement of semen quality in 6 months after operation in two groups was 73.3% (22/30)and 60% (18/30),respectively.There were significant differences in above indexes between two groups (P <0.05).The recurrence rate of two groups was 6.7% (2/30)and 3.3% (1/30)respectively,and there was no significant difference between two groups (P >0.05).Conclusions:High selective laparoscopic ligation of spermatic vein with spermatic artery preservation requires shorter operation time,has low incidence of postoperative complications and high improvement rate of semen quali-ty,while leading to no more recurrence rate,and is worth to be extended in clinics.