显微镜手术与腹腔镜手术治疗精索静脉曲张合并男性不育症的临床疗效分析  

Clinical efficacy of microscopic varicocelectomy versus laparoscopic varicocelectomy in the treatment of varicocele with male infertility

作　　者：潘瑜 傅玲 郭晓静[1] 李文鑫 钱林 于磊[1] 王洪强[1] 张开舒 李慎谦[1] 李强[1] 王沛涛[1] 王瀚枢 荆涛[1] PAN Yu;FU Ling;GUO Xiao-jing;LI Wen-xin;QIAN Lin;YU Lei;WANG Hong-qiang;ZHANG Kai-shu;LI Shen-qian;LI Qiang;WANG Pei-tao;WANG Han-shu;JING Tao(Department of Andrology,The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China;Department of Urology,The Affiliated Hospital of Qingdao University,Qingdao,Shandong 266000,China)

机构地区：[1]青岛大学附属医院男性科,山东青岛266000 [2]青岛大学附属医院泌尿外科,山东青岛266000

出　　处：《中华男科学杂志》2025年第4期333-337,共5页National Journal of Andrology

基　　金：山东省自然科学基金(ZR2023QH491)。

摘　　要：目的:对比分析显微镜手术与腹腔镜手术治疗精索静脉曲张(VC)合并男性不育症患者的临床疗效。方法:回顾性分析青岛大学附属医院2018年10月至2022年10月收治的307例VC合并男性不育症患者,根据不同手术方式分为显微镜组180例,腹腔镜组127例。显微镜组患者均接受显微镜下精索静脉低位结扎术,腹腔镜组患者均接受腹腔镜下精索静脉高位结扎术。对比分析两组患者在术前、术后的临床指标,包括精索静脉扩张程度、返流时间、睾丸包膜动脉血流动力学参数、前向运动精子百分率(PR%)、精子浓度、正常形态精子百分率,并比较两组患者术后随访2年内配偶妊娠情况以及并发症发生率。结果:显微镜组及腹腔镜组共307例患者均顺利完成手术治疗,显微镜组和腹腔镜组在手术时间、住院时间及住院治疗费用方面的差异无统计学意义(P>0.05);术后复查彩色多普勒超声(CDFI)显示,显微镜组患者的精索静脉最大直径、返流时间、睾丸包膜动脉血流动力学参数的改善均优于腹腔镜组(P<0.05);两组患者术后精液分析结果显示,显微镜组患者的PR%、精子浓度、正常形态精子百分率改善程度均显著高于腹腔镜组(P<0.05);两组患者术后2年随访期内,显微镜组配偶妊娠率为67.2%,腹腔镜组为47.2%,两组比较差异有统计学意义(P<0.05),且显微镜组术后2年内妊娠等待时间显著短于腹腔镜组(P<0.05)、不良孕产史发生率显著低于腹腔镜组(P<0.05),同时显微镜组成功妊娠的配偶自然受孕率显著高于腹腔镜组(P<0.05);两组患者术后随访期内,均未出现睾丸萎缩、出血、感染等并发症,但是腹腔镜组术后睾丸鞘膜积液发生率、术后复发率均高于显微镜组(P<0.05)。结论:显微镜下精索静脉低位结扎术与腹腔镜下精索静脉高位结扎术两种手术方式均可应用于临床治疗VC合并男性不育症患者,但是显微镜手术在改善�Objective:To compare the clinical efficacy between microscopic varicocelectomy and laparoscopic varicocelectomy in the treatment of varicocele(VC)with male infertility.Methods:A total of 307 patients who were diagnosed with VC complicated with male infertility and admitted to the Affiliated Hospital of Qingdao University from October 2018 to October 2022 were recruited for retrospective analysis.The patients were divided into the microscopic group(180 cases)and laparoscopic group(127 cases)according to the surgery method.The pre-and postoperative clinical data of these two groups were analyzed,including the degree of dilatation and reflux time of internal spermatic vein,hemodynamic parameters of testicular capsular artery,proportion of progressive motility spermatozoa(PR),concentration of spermatozoa,proportion of normal morphology sperm,the pregnancy outcome of spouses and the incidence of complications related with surgery within 2 years postoperatively.Results:All the surgeries for the 307 patients in this study were successful.There was no significant difference in operation time,hospitalization time and management expenses between the microscopic group and the laparoscopic group(P>0.05).Compared to the patients in laparoscopic group,the patients in the microscopic group received a better improvement in venous diameter,reflux time of spermatic veins and hemodynamic parameters of testicular capsular artery(P<0.05).Moreover,the semen analysis showed that the PR,spermatozoa concentration and proportion of normal morphology sperm in the microscopic group were also obviously increased than those in the laparoscopic group(P<0.05).During the 2-year follow-up period,the conception rate of spouses in the microscopic group was 67.2%,while only 47.2%in the laparoscopic group,in which the difference was statistically significant(P<0.05).Besides,the time-to-pregnancy(TTP)within 2 years postoperatively in the microscopic group was significantly shorter than that in the laparoscopic group(P<0.05).Meanwhile,the incidence of

关 键 词：精索静脉曲张 男性不育 显微镜手术 腹腔镜手术 精液质量 妊娠率 

分 类 号：R697.24[医药卫生—泌尿科学]