保留睾丸动脉的腹腔镜精索内静脉高位结扎术对精索静脉曲张致不育的疗效分析  

Effect of laparoscopic high ligation of internal spermatic vein with testicular artery preservation on infertility caused by varicocele

作　　者：王晓利[1] 李琦[1] 李春风 王璟琦 管晓东 Wang Xiaoli;Li Qi;Li Chunfeng;Wang Jingqi;Guan Xiaodong(Department of Urology,Yuncheng Hospital Affiliated to Shanxi Medical University,Yuncheng 044000,China;Department of Urology,the First Hospital of Shanxi Medical University;Department of Urology,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学附属运城医院泌尿外科,运城044000 [2]山西医科大学第一医院泌尿外科,太原030001 [3]山西医科大学第二医院泌尿外科

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第3期261-264,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探究腹腔镜下精索内静脉高位结扎术中通过保留睾丸动脉对治疗精索静脉曲张导致不育的临床疗效。方法回顾性分析2014年1月至2016年12月山西医科大学第一医院行腹腔镜手术治疗的精索静脉曲张伴不育患者,共完整收集病例资料69例,按照腹腔镜精索静脉高位结扎术中对睾丸动脉处理方式的不同,将其分为两组。A组:保留睾丸动脉36例;B组:精索血管集束结扎33例。统计比较两组患者精子质量改善情况,自然生育率,并发症和复发率。结果精子质量改善情况:(1)两组术后较术前均有明显改善(P<0.05);(2)两组比较,A组精子密度和精子活力改善率均高于B组(P<0.05);自然生育率比较:A组生育率高于B组(P<0.05)。并发症发生情况:(1)两组各有3例睾丸鞘膜积液,差异无统计学意义(P>0.05);(2)A组无睾丸萎缩,B组有1例睾丸萎缩,A、B组比较差异无统计学意义(P>0.05)。复发率比较:A组有1例复发,B组有2例复发,两组比较差异无统计学意义(P>0.05)。结论对于精索静脉曲张不育患者,两种手术方式都可以明显地改善精子密度和活力,但保留睾丸动脉组的精子质量改善情况和自然生育率显著优于集束结扎组,而在并发症(睾丸鞘膜积液、萎缩)和复发率方面,两组无显著差别。Objective To explore the clinical efficacy of laparoscopic high ligation of internal spermatic vein in the treatment of infertility caused by varicocele by preserving testicular artery.Methods 69 cases of infertile patients with varicocele from January 2014 to December 2016 of the First Hospital of Shanxi Medical University were analyzed retrospectively.According to the surgical method,the patients were divided into two groups.Group A:36 cases were reserved for the testicular artery,group B:33 cases were ligated by the cluster of spermatic vessels.The sperm quality improvement,natural fertility rate,postoperative complication rate and recurrence rate were compared between the two groups,and the clinical effects of the two surgical methods were analyzed and evaluated.Results Semen parameters improvement:(1)there was significant improvement in two groups after operation compared with those before operation(P<0.05);(2)the improvement rate of sperm density and motility in group A was higher than those in group B(P<0.05).Natural fertility:the fertility rate of group A was higher than that of group B(P<0.05).Complications:(1)there were 3 cases of hydrocele in the testis in both groups and the difference between the two groups was not statistically significant(P>0.05);(2)there was no testicular atrophy in group A,and there was 1 case of testicular atrophy in group B,the difference between the two groups was not statistically significant(P>0.05).Recurtence rate:there was 1 case of relapse in group A and 2 cases in group B and the difference between the two groups was not statistically significant(P>0.05).Conclusions The sperm quality recovery and natural fertility of the reserved testicular artery group are superior to those of the spermatic vessel cluster ligation group.There was no significant difference in the hydrocele of the testicle,atrophy of the testis and the recurrence of varicocele between the two methods.

关 键 词：精索静脉曲张 不育 腹腔镜 精索静脉结扎术 睾丸动脉 集束结扎 精准治疗 

分 类 号：R699.8[医药卫生—泌尿科学]