精索静脉曲张不育症患者显微外科术中结扎引带静脉与否的临床探究  

Clinical research on whether to ligate the gubernaculum vein during microsurgery of infertile patients with varicocele

作　　者：高培廷 张立卿 GAO Peiting;ZHANG Liqing(Department of Urology,960th Hospital of Chinese PLA,Jinan 250031,China)

机构地区：[1]解放军第960医院泌尿外科,济南250031

出　　处：《临床与病理杂志》2021年第12期2912-2917,共6页Journal of Clinical and Pathological Research

摘　　要：目的:探讨精索静脉曲张(varicocele,VC)不育症患者显微外科术中提出睾丸结扎引带静脉与否的疗效差异。方法:回顾性分析84例接受显微镜下精索静脉结扎术(microsurgical subinguinal varicocelectomy,MSV)的VC不育症患者的病历资料,根据术中是否结扎引带静脉,分为A组(38例)与B组(46例)。A组MSV术中提出睾丸结扎引带静脉,B组MSV术中未提出睾丸结扎引带静脉,比较两组手术时间、并发症、精液质量参数以及术后随访配偶自然受孕情况。结果:两组均成功完成手术,组间阴囊水肿发生率、睾丸鞘膜积液发生率比较,差异无统计学意义(P>0.05),B组手术时间短于A组,差异有统计学意义(P <0.05)。两组Ⅱ级、Ⅲ级患者术后3个月精子密度、A级精子百分比、 A+B级精子百分比均较术前提高,差异有统计学意义(P <0.0 5),组间上述精液质量参数比较,差异均无统计学意义(均P>0.05)。两组术后12个月均未见VC复发,组间配偶自然受孕率比较,差异无统计学意义(P>0.05)。结论:VC不育症患者MCV术中提出睾丸结扎引带静脉与否对手术疗效无明显影响,建议不结扎引带静脉,缩短手术时间。Objective:To investigate the effect of whether to ligate the gubernaculum vein on infertile patients with varicocele(VC) during microsurgery.Methods:The clinical data of 84 patients with VC infertility who underwent microsurgical subinguinal varicocelectomy(MSV) were retrospectively analyzed.According to whether the varicocele was ligated during the operation,they were divided into group A(n=38) and group B(n=46).In group A,testis was raised and the gubernaculum was ligated,but in group B,testis was not raised and the gubernaculum was not ligated.The operation time,complications,semen quality parameters and natural pregnancy of spouses were compared between the two groups.Results:The operation was successfully completed in both groups.There was no significant difference in the incidence of scrotal edema and the incidence of testicular hydrocele between the two groups(P>0.05).The operation time in group B was shorter than that in group A,and the difference was statistically significant(P<0.05).The sperm density,the percentage of grade a sperm and the percentage of Grade A + B sperm in the two groups at the 3 rd month after the operation were significantly higher than those before operation(P<0.05).There was no significant difference in the above semen quality parameters between the two groups(P>0.05).There was no recurrence of VC in the two groups 12 months after the operation,and there was no significant difference in the natural pregnancy rate between the two groups(P>0.05).Conclusion:There is no significant effect on the curative effect of MCV with or without ligation of the gubernaculum in patients with VC infertility.It is suggested that tthe gubernaculum vein should not be ligated to shorten the operation time.

关 键 词：精索静脉曲张 不育症 显微外科术 引带静脉 精液质量 并发症 配偶受孕率 

分 类 号：R699.8[医药卫生—泌尿科学]