显微镜下Ⅱ、Ⅲ度精索静脉曲张患者同时结扎精索内、外静脉及引带静脉的疗效  

The effect of ligation of internal and external spermatic veins and gubernacular veins in patients with gradeⅡandⅢvaricocele under microsurgical subinguinal varicocelectomy

作　　者：文焰林 张宗平 王安果 伍季 李云祥 姜滔 罗照 Wen Yanlin;Zhang Zongping;Wang Anguo;Wu Ji;Li Yunxiang;Jiang Tao;Luo Zhao(Department of Urology,Nanchong Central Hospital(The Second Clinical Hospital of North Sichuan Medical College),Nanchong 637000,China)

机构地区：[1]南充市中心医院(川北医学院第二临床学院)泌尿外科,南充637000

出　　处：《国际泌尿系统杂志》2023年第4期683-687,共5页International Journal of Urology and Nephrology

基　　金：南充市2018年市校战略合作科技项目(18SXHZ0121);川北医学院研究生教育教学改革研究项目(PGJG2022009)。

摘　　要：目的评估显微镜下Ⅱ、Ⅲ度精索静脉曲张患者同时结扎精索内、外静脉及引带静脉的疗效。方法选取2019年1月至2020年6月在本院就诊的60例单侧Ⅱ、Ⅲ度精索静脉曲张患者的临床资料,随机分为对照组和试验组,每组各30例。对照组采用外环下显微镜精索静脉结扎术结扎精索内静脉,试验组术中同时结扎精索内、外静脉及引带静脉。比较两组患者的手术时间、并发症以及术前、术后3个月的精液质量、视觉模拟疼痛评分(VAS)、血清睾酮等指标。结果两组患者的术后精液质量、精子密度和精子活动率(A+B级精子)较术前显著改善(均P<0.05);两组患者的术后3个月睾酮水平比较,差异无统计学意义(P>0.05)。试验组的手术时间短于对照组,差异有统计学意义(P=0.002)。两组患者的术前、术后3个月VAS比较,差异均无统计学意义(均P>0.05)。对照组术后有1例患者发生阴囊水肿,试验组有8例患者发生阴囊水肿,两组比较差异有统计学意义(P<0.05)。两组患者均无术后感染、鞘膜积液和睾丸萎缩发生。结论采用外环下显微镜精索静脉结扎术结扎精索内静脉或同时结扎精索内、外静脉及引带静脉治疗Ⅱ、Ⅲ度精索静脉曲张患者均可以显著改善患者的精液质量和缓解阴囊疼痛,并且提高血清睾酮水平,但是同时结扎精索内、外静脉及引带静脉的手术时间较长,术后阴囊水肿发生率较高,但患者自觉症状改善体验较佳,两种手术方式均是安全有效的。Objective To evaluate the efficacy of ligation of internal and external spermatic veins and gubernacular veins in patients with gradeⅡandⅢvaricocele under microsurgical subinguinal varicocelectomy.Methods From January 2019 to June 2020,60 patients with unilateral gradeⅡandⅢvaricocele in our hospital were prospectively studied.They were randomly divided into control group and experimental group,with 30 cases in each group.The control group were treated with internal spermatic vein were ligated under microsurgical subinguinal varicocelectomy,while the experimental group were treated with internal spermatic vein,external spermatic vein and gubernacular veins were ligated at the same time.The operation time,complications,semen quality and visual analogue scale(VAS score)before and three months after operation were compared between the two groups,serum testosterone and other related data were analyzed statistically.Results Postoperative semen quality,sperm density and sperm motility(grade A+B sperm)of 2 groups were significantly improved compared with preoperative,with statistical significance(all P<0.05).There was no significant difference in testosterone level 3 months after surgery between the two groups(all P>0.05).The operation time of experimental group was shorter than that of control group,and the difference was statistically significant(P=0.002).There was no significant difference in postoperative VAS and 3 months VAS between 2 groups(all P>0.05).Postoperative scrotal edema occurred in 1 patient in the control group and 8 patients in the experimental group,and the difference between the two groups was statistically significant(P<0.05).No postoperative infection,hydrocele or atrophy occurred in the two groups.Conclusions Microsurgical subinguinal varicocelectomy and ligation of internal and external spermatic veins and gubernacular veins in patients with gradeⅡandⅢvaricocele can significantly improve semen quality and relieve scrotal pain and increase serum testosterone level in patients,However,th

关 键 词：精索静脉曲张 显微镜检查 结扎术 静脉 

分 类 号：R697.24[医药卫生—泌尿科学]