局部麻醉下两种显微镜下精索静脉曲张手术方式疗效分析

摘要

目的:对比分析在局部麻醉下行显微镜两种精索静脉结扎手术方式治疗精索静脉曲张的疗效.方法:127例精索静脉曲张患者,其中73例接受了显微镜下在外环口单纯将精索内静脉结扎(A组),54例接受除精索内静脉结扎之外的提睾肌静脉、输精管静脉及引带静脉均游离并结扎(B组).对两组手术时间、并发症发生情况以及术后精液分析改善情况进行对比分析.结果:A组手术时间(49±14) min,B组手术时间(68±9)min,手术时间比较差异有统计学意义(P＜0.05);术后并发症两组比较,A组术后阴囊水肿2例,1例并发附睾炎,B组阴囊水肿8例,鞘膜积液5例,附睾炎3例,发生率差异有统计学意义(P＜0.05);两组术后均未复发.两组术后精子质量均有显著改善,A组术后精子计数(39.4±4.21)×106/mL、活率(59.05±4.32)％,B组术后精子计数(37.65±5.68)×106/mL、活率(58.46±5.76)％,差异无统计学意义(P＞0.05).结论:显微镜下精索内静脉低位结扎术治疗精索静脉曲张患者易于接受、术后并发症少,手术时间短,精子质量改善显著,优于显微镜下低位精索内静脉+其余静脉均结扎手术组.%Objectives:To evaluate the effect of two approaches of microsurgical varicocelectomy under local anesthesia for the treatment of varicocele.Methods:A total of 127 patients with clinically diagnosed varicoceles who underwent surgical ligation with (n =54) or without (n =73) ligation of the vein of cremaster and gubernaculum were followed up postoperatively at 3 months to 1 year.The postoperative outcome was assessed by determination of the surgical times,complications,semen parameters and varicocele recurrence.Results:The operation time of group B was longer than that of group A [(68 ± 9) min vs.(49 ± 14) min,P ＜ 0.05],and the incidence of scrotal edema,epididymitis and hydrocele testis in group A was lower than these in group B [group A:2 cases of scrotal edema (2.7％),1 case of epididymitis (1.3％);group B:8 cases of scrotal edema (14.8％),3 case of epididymitis (5.5％) and 5 cases of hydrocele testis (9.3％)].No varicocele recurrence was clinically detectable after either surgical approach.The sperm count and sperm motility in group A was (39.4 ± 4.21) × 106/mL and (59.05 ± 4.32) ％,while those in group B were (37.65 ± 5.68) × 106/mL and (58.46 ± 5.76) ％ respectively,without significant difference between the two groups (P ＞ 0.05).Conclusion:Varicocelectomy without ligitaion of the vein of cremaster and gnbernaculums has equivalent or more beneficial effects on semen parameters without affecting varicocele recurrence rate.It shows great advantages over microsurgical varicocelectomy performed with ligitaion of the vein of cremaster and gubemaculum.