双侧精索静脉曲张手术治疗方式选择的探讨  

Comparative analysis of surgical treatment methods for bilateral varicocele

作　　者：张立元[1] 张小康[1] 剡锐 常鹏程 景锁世 杨捷 Zhang Liyuan;Zhang Xiaokang;Yan Rui;Chang Pengcheng;Jing Suoshi(Yang Jie11.The Second Urology Department of The First Hospital of Lanzhou University,Lanzhou,Gansu 730000,China;The Andro-urological Department of The First Hospital Donggang Branch of Lanzhou University,Lanzhou,Gansu 730000,China)

机构地区：[1]兰州大学第一医院泌尿二科,甘肃兰州730000 [2]兰州大学第一医院东岗院区泌尿男科,甘肃兰州730000

出　　处：《中国男科学杂志》2021年第2期50-53,共4页Chinese Journal of Andrology

基　　金：兰州市科技计划项目(2012-1-27);兰州市人才创新创业项目(2014-RC-66)。

摘　　要：目的通过比较腹腔镜高选择性精索静脉结扎术与显微镜精索静脉结扎术治疗双侧精索静脉曲张的疗效、手术时间及并发症,探讨双侧精索静脉曲张的手术方式选择。方法回顾性分析2012年12月至2018年12月我院收治的342例双侧精索静脉曲张合并不育患者的临床资料,按手术方式分为腹腔镜(252例)组和显微镜组(90例),比较两组患者的精液质量改善情况、手术时间、术后配偶怀孕率、并发症及复发率。结果两组患者术后12月的精子浓度、向前运动精子百分率、精子活动率均较手术治疗前有显著改善,差异具有统计学意义(P<0.05);术后显微镜组与腹腔镜组的精子浓度、向前运动精子百分率、精子活动率改善,无统计学差异(P<0.05)。腹腔镜组的手术时间显著短于显微镜组,差异有统计学意义(P<0.05);显微镜组术后配偶怀孕率比腹腔镜组高,但差异无统计学意义(P>0.05);显微镜组术后复发率低于腹腔镜组,差异有统计学意义(P<0.05),显微镜组并发症发生率低于腹腔镜组,但无统计学意义(P>0.05)。结论对于双侧精索静脉曲张,腹腔镜高选择性精索静脉结扎术操作更简单、手术时间明显较短、术后恢复快,能够达到显微镜的类似治疗效果。Objective To evaluate two surgical treatment methods such as transperitoneal laparoscopic high-selective varicocelectomy and microscopic varicocelectomy for bilateral varicocele by comparing their efficacy, operation time and complications. Methods Clinical data of 342 infertile patients with bilateral varicocele in our hospital from December 2012 to December 2018 were retrospectively analyzed. All the patients were divided into laparoscopy(252 cases) and microscope group(90 cases). Semen quality, operation time, the rate of spousal pregnancy, complications and recurrence rate were compared between the two groups. Results The sperm concentration, forward motility rate, sperm motility rate and sperm abnormality rate of the two groups were significantly improved at the twelfth month after operation, and the difference was statistically significant(P<0.05). There were no significant differences in the rate of sperm motility and sperm deformity between the two groups(P>0.05). The operative time in the laparoscopic group was significantly shorter than that in the microscope group, the difference was statistically significant(P<0.05). The rate of spousal pregnancy in the microscope group was slightly higher than that in laparoscopic group(P>0.05), and the recurrence rate in the microscope group was significantly lower than that in the laparoscope group(P<0.05), and the complications in the two groups were not statistically different(P>0.05). Conclusion Laparoscopic high-selective varicocelectomy has a significant advantage in the treatment of bilateral varicocele, the operation is simpler, the operation time is shorter, and the postoperative recovery is faster. It can achieve the same therapeutic efficacy of microscopic varicocelectomy.

关 键 词：精索静脉曲张 精索静脉结扎术 显微镜检查 腹腔镜检查 男性 不育 

分 类 号：R698.2[医药卫生—泌尿科学] R699.8[医药卫生—外科学]