显微镜外环下精索静脉结扎术与腹腔镜精索静脉高位结扎术治疗精索静脉曲张的对比研究  

Comparison of spermatic vein ligation under the outer ring of the microscope and laparoscopic high ligation of spermatic vein in the treatment of varicocele

作　　者：蓝杰[1] 覃江[1] 韦克暖[1] Lan Jie;Qin Jiang;Wei Kenuan(Department of Urology,Hechi People’s Hospital,Hechi 547000,Guangxi,China)

机构地区：[1]广西河池市人民医院泌尿外科,广西河池547000

出　　处：《右江民族医学院学报》2022年第3期427-431,444,共6页Journal of Youjiang Medical University for Nationalities

基　　金：河池市科学研究与技术开发计划项目(河科B1824-6)。

摘　　要：目的观察比较显微镜外环下精索静脉结扎术与腹腔镜精索静脉高位结扎术治疗精索静脉曲张术后阴囊水肿、手术相关疼痛、睾丸萎缩、静脉曲张复发及精液质量改善情况。方法收集2018年5月—2021年4月于河池市人民医院泌尿外科住院的精索静脉曲张患者122例,均为Ⅱ°以上静脉曲张,或双侧精索静脉曲张,随机分成两组,其中显微镜下经外环口高选择性保留精索内动脉、淋巴管的精索静脉低位结扎术组(显微镜组)70例,腹腔镜精索静脉高位结扎术组(腹腔镜组)52例,比较两组患者手术时间、术后并发症(阴囊水肿、手术相关疼痛、睾丸萎缩、静脉曲张复发)的发生率及精液质量改善情况。结果两组患者术前精液的各项指标比较,差异无统计学意义(P>0.05),两组患者术后精液的精子总数、精子密度、前向运动精子率的差异无统计学意义(P>0.05),精子总活力的差异具有统计学意义(P=0.042);显微镜组的术后精子总活力高于腹腔镜组的术后精子总活力;组内术前、术后精液的各项指标比较,显微镜组精子总数术前、术后的差异无统计学意义(P=0.157),术后精子密度、精子总活力、前向运动精子率优于术前(P<0.05),腹腔镜组术前、术后的精子总数、精子密度、精子总活力的差异无统计学意义(P>0.05),术后前向运动精子率优于术前(P<0.05);两组术前、术后精液指标差值的比较,两组的术前、术后精子总数差值的差异无统计学意义(P=0.176),显微镜组的精子密度差值、精子总活力差值大于腹腔镜组,差异具有统计学意义(P<0.05)。显微镜组手术时间长于腹腔镜组,差异有统计学意义(P<0.001),术后阴囊水肿发生率显微镜组低于腹腔镜组,差异有统计学意义(P=0.012),手术相关疼痛发生率、静脉曲张复发率两组比较差异无统计学意义,两组均无睾丸萎缩发生。结论显微镜外环下精索静脉结扎术治疗精�Objective To observe and compare the scrotal edema,surgery-related pain,testicular atrophy,varicocele recurrence and semen quality improvement after spermatic vein ligation under the outer ring of the microscope and the same indicators of laparoscopic high ligation of spermatic vein in the treatment of varicocele.Methods This study collected a total of 122 patients with varicocele hospitalized in the Department of Urology of Hechi People’s Hospital from May 2018 to April 2021.All of them had varicocele aboveⅡ°or bilateral varicocele.They were randomly divided into two groups,including 70 cases in the microscope group and 50 cases in the laparoscopic group.The microscope group underwent low spermatic vein ligation with highly selective preservation of internal spermatic artery and lymphatic vessels under the outer ring of the microscope;the laparoscopic group underwent laparoscopic high ligation of spermatic vein.The research went on to compare the duration of operation,incidence of postoperative complications(scrotal edema,surgery-related pain,testicular atrophy,varicocele recurrence)and improvement of semen quality between two groups.Results There was no significant difference in preoperative semen indicators between two groups(P>0.05).There were also no statistically significant differences in postoperative sperm count,sperm density and forward motile sperm rate between two groups(P>0.05),but there were statistically significant differences in total sperm motility between two groups(P=0.042).The total sperm motility in the microscope group was higher than that in the laparoscopic group.Comparison of semen indicators before and after operation in each group showed that there was no significant difference between preoperative and postoperative sperm count in the microscope group(P=0.157).And their postoperative sperm density,total sperm motility and forward motile sperm rate were better than those before surgery(P<0.05).There were no significant differences in total sperm count,sperm density and sperm motili

关 键 词：精索静脉曲张 显微镜 腹腔镜 精索静脉高位结扎术 

分 类 号：R699.8[医药卫生—泌尿科学]