【摘要】 目的:比较外环下显微精索静脉结扎术提出睾丸结扎引带静脉与不提出睾丸保留引带静脉的疗效及并发症。方法:回顾性总结163例精索静脉曲张患者术前及术后的临床资料,其中提出睾丸40例,不提出睾丸123例。比较不同手术方法在手术时间、术后并发症、复发率,以及术前、术后3个月精液质量的差异。结果:提出睾丸组手术时间(81.1±20.0)min,不提出睾丸组手术时间(62.3±9.6)min,两组间有统计学差异(P=0.041)。两组术后精子存活率、前向运动精子百分率、精子浓度以及1次射精总数均较术前显著改善(P<0.05)。其中提出睾丸组Ⅲ度精索静脉曲张32例,不提出睾丸组Ⅲ度精索静脉曲张62例。两组间Ⅲ度曲张患者术前精子存活率、前向运动精子百分率、精子浓度、1次射精精子总数及术后3个月精子存活率、前向运动精子百分率、精子浓度、1次射精精子总数均无统计学差异(P均>0.05)。提出睾丸组术后5例患者伴有阴囊水肿,不提出睾丸组术后2例患者伴有伤口感染。两组患者均无睾丸萎缩及精索静脉曲张复发。结论:外环下显微精索静脉结扎术提出睾丸结扎引带静脉与不提出睾丸保留引带静脉相比较,并没有更好的减少复发率和提高精液参数,反而更加延长手术时间以及引起阴囊水肿等并发症的发生。更多还原

【Abstract】 Objective: To compare the clinical effects and postoperative complications of microsurgical subinguinal varicocelectomy( MSV) with or without delivery of the testis and ligation of gubernacular veins in the treatment of varicocele. Methods: We retrospectively analyzed the clinical data about 163 varicocele patients treated by MSV,40 with( group A) and the other 123 without delivery of the testis and ligation of gubernacular veins( group B). We compared the operation time,postoperative complications,rate of recurrence,and semen parameters before and at 3 months after surgery between the two groups of patients. Results: The operation time was significantly longer in group A than in B( [81. 1 ± 20. 0]vs [62. 3 ± 9. 6]min,P = 0. 041). Sperm concentration,total sperm count per ejaculate,sperm viability,and the percentage of progressively motile sperm were significantly improved in both groups at 3 months after MSV as compared with the baseline( P < 0. 05). There were no statistically significant differences in the above semen parameters between the two groups of patients with grade Ⅲ varicocele before and after surgery( P < 0. 05). Scrotal edema developed in 5 cases in group A and wound infection in 2 cases in group B after MSV,but no postoperative testicular atrophy or recurrence was observed in either of the two groups. Conclusion: MSV with delivery of the testis and ligation of gubernacular veins showed no advantages over that without in reducing varicocele recurrence and improving semen parameters,but rather involved longer operation time and a higher incidence rate of postoperative complications.更多还原