腹腔镜辅助下不同术式精索内静脉高位结扎术治疗精索静脉曲张的临床效果  

Clinical effect of internal spermatic vein high ligation with different operation methods on treatment of patients with varicocele

作　　者：罗建仕[1] 陈光[1] 曾四平[1] 沈思[1] 杨江[1] 管刚云[1] 詹谊[1] 

机构地区：[1]广西医科大学第四附属医院泌尿外科,广西柳州545005

出　　处：《实用临床医药杂志》2015年第3期63-66,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨腹腔镜辅助下不同术式精索内静脉高位结扎术治疗精索静脉曲张的疗效。方法 168例原发性精索静脉曲张患者随机分为精索全结扎组(n=56)、保留睾丸动脉组(n=56)和静脉结扎组(n=56)。比较3组患者术前,术后6个月的精液质量、近远期并发症、生育、复发及卵泡刺激素(FSH)。结果 3组术后精子密度、精子活率、畸形精子及FSH浓度均较同组术前明显改善(P<0.05),且静脉结扎组的改善程度最好,精索全结扎组最差(P<0.05)。静脉结扎组术后继发性鞘膜积液发生率明显低于其他2组(P<0.05)。精索全结扎组术后睾丸萎缩发生率明显高于其他2组(P<0.05)。静脉结扎组妊娠率明显高于其他2组(P<0.05)。结论采用仅结扎精索内静脉,保留睾丸动脉和精索淋巴管道的术式能更有效地提高精索静脉曲张患者术后精子质量,降低术后并发症及提高其配偶妊娠率。Objective To explore the effect of internal spermatic vein high ligation with different operation methods on treatment of patients with varicocele. Methods A total of 168 patients with primary varicocele were randomly divided into total spermatic cord ligation group（ n = 56）,testicular artery preservation group（ n = 56） and venous ligation group（ n = 56）. The semen quality,short and long term complications,fertility,recurrence and FSH before operation and 6 months after operation were compared among three groups. Results After operation,the sperm density,sperm motility,sperm deformity and FSH concentrations significantly improved in all the groups（ P〈0. 05）,and of the three groups,the degree of improvement was the greatest in the venous ligation group,while was the worst in the total spermatic cord ligation group（ P〈0. 05）. The incidence rate of postoperative secondary hydrocele in the venous ligation group was significantly lower than that in the other two groups（ P〈0. 05）. The incidence rate of testicular atrophy in the total spermatic cord ligation group was significantly higher than that in the other two groups（ P〈0. 05）. The pregnancy rate of the vein ligation group was significantly higher than that of the other two groups（ P〈0. 05）. Conclusion Application of surgical method of ligating internal spermatic vein only and preserving testicular artery and spermatic lymph pipeline can effectively improve sperm quality of patients with varicocele,reduce postoperative complications and improve pregnancy rate of spouse.

关 键 词：腹腔镜 精索内静脉高位结扎术 精索静脉曲张 Palomo术式 

分 类 号：R697[医药卫生—泌尿科学]