腹股沟外环下显微精索静脉结扎术临床疗效观察分析  

Curative effect of subinguinal microsurgical varicocelectomy for varicocele

作　　者：王金国 谭艳[1] 王万荣[1] 谢子平[1] 欧阳海[1] 李韬[1] 康照鹏[1] 谢胜[1] 

机构地区：[1]湖北医药学院附属十堰市人民医院男科,湖北十堰442000

出　　处：《中国性科学》2017年第9期10-13,共4页Chinese Journal of Human Sexuality

摘　　要：目的:探讨腹股沟外环下显微精索静脉结扎术的临床疗效。方法:回顾分析2013年5月至2016年5月采用腹股沟外环下显微精索静脉结扎术治疗528例精索静脉曲张患者的临床资料,单纯左侧曲张410例,双侧曲张118例;阴囊坠胀不适、隐痛患者333例,不育患者195例,术后3、6个月随访并发症发生情况及精液指标改善等情况。结果:住院期间单纯左侧患者的平均手术时间(48.1±5.1)min、双侧患者平均手术时间(88.2±4.8)min、术中出血量(4.7±1.3)mL、平均住院时间(7.9±0.58)d;获得有效随访6个月~2年的患者488例,失访40例,术前睾丸坠胀、隐痛等随访的307例患者,术后症状消失者218例(71.2%),减轻75例(24.4%),无改善14例(4.6%),术后阴囊水肿10例、附睾炎发生3例、复发5例,无睾丸鞘膜积液、睾丸萎缩等情况发生。随访181例婚后不育患者随访12个月,配偶受孕59例(32.6%);随访不育及少弱精455例患者中,36例患者无改善,419例患者术前精子浓度、向前运动精子百分比、活动精子、正常形态精子、精子畸形指数为(9.24±1.38)×10~6/mL、(10.23±1.19)%、(38.27±14.23)%、(8.19±4.53)%、(2.67±1.79);术后3个月及6个月分别为(16.59±7.07)×10~6/mL、(20.27±8.31)%、(47.56±19.11)%、(10.87±6.22)%、(2.08±1.22);(39.49±13.57)×10~6/mL、(31.25±10.28)%、(69.24±9.34)%、(17.23±9.78)%、(1.85±0.73),均较术前显著改善(P<0.05)。结论:经腹股沟显微精索静脉结扎术可有效改善精索静脉曲张的临床症状,减少术后并发症的发生,有效提高精子浓度、向前运动精子百分比、活动精子、正常形态精子,并降低精子畸形指数。Objectives： To investigate the clinical effect of subinguinal microsurgical/varicocelectomy. Methods ： The clinical data of 528 patients who were treated by subingninal microsurgical varicocelectomy from May 2013 to May 2016 were retrospectively analyzed. There were 410 cases of varicocele on the left side and 118 cases of varicocele on both sides; 333 cases of testicular pain or dragging and distending discomfort, and 195 cases of infer- tility. Complications and semen parameters at 3 and 6 months after the operation were observed. Results： The oper- ation time for the left side varicocele and both sides varicocele were （48.1 ± 5.1 ） min and （88.2 ± 4.8 ） min, re- spectively. The bleeding loss during operation was （4.7 ± 1.3 ） ml and the average hospitalization time was （7.9 ± 0. 58 ） d. 408 patients were followed up for 6 months to 2 years, and 40 patients were lost. There were 307 cases of testicular pain before operation. After operation, there were 218 cases with no discomfort （71.2%）, 75 cases with improvement （24.4%） and 14 cases with no improvement （4.6%）. There were 10 cases of scrotum edema, 3 ca- ses of epididymitis and 5 cases of recurrence. No hydrocele of testis and testicular atrophy occurred. There were 59 cases of pregnancy （32.6%） among the 181 cases of infertility after 12 months＇ follow - up. The 419 followed - up patients with infertility or oligoasthenospermia all showed significantly improvement in sperm concentration, progres- sive motility （ % ）, alive spermatozoa （ % ）, normal forms （ % ） and sperm deformity index （ SDI ）, which were （16.59±7.07） ×10^6/ml, （20.27±8.31）%, （47.56±19.11）% ,（10.87±6.22）% and （2.08±1.22） at3 months after operation, and （39.49 ± 13.57 ） ×10^6/ml, （31.25 ± 10. 28 ） % , （69. 24 ± 9. 34） % , （ 17.23 ± 9. 78）% and （ 1.85 ±0. 73） at 6 months after operation, compared with the （9.24 ± 1.38）×10^6/ml, （ 10. 23 ± 1.19）%, （38. 27 ± 14. 23）%, �

关 键 词：精索静脉曲张 显微外科 精索静脉结扎术 并发症 

分 类 号：R697.24[医药卫生—泌尿科学]