【摘要】 目的:分析显微镜下不同的手术方式治疗精索静脉曲张的效果。方法:选取2015年4月至2016年4月在新疆医科大学第一附属医院泌尿外科就诊的210例因精索静脉曲张导致不育的患者,选取其中左侧静脉曲张患者82例,将其随机分成两组,每组41例。对照组给予显微镜下经腹股沟精索静脉结扎术,观察组给予显微镜下经外环下精索静脉结扎术。观察并比较两组患者的手术时间,住院时间,切口疼痛评分,手术前后精子质量和相关分子生物学指标水平,术后并发症及随访情况。结果:观察组患者手术时间显著长于对照组患者,住院时间和切口疼痛评分显著低于对照组,其差异具有统计学意义(P<0.05)。两组患者术后的精子浓度、精子活力、精子活动率较术前相比均显著改善,其差异具有统计学意义(均P<0.05);观察组患者的上述精液质量指标均高于对照组,其差异具有统计学意义(均P<0.05)。两组患者术后精液中HSP70,血液中的去甲肾上腺素浓度均低于术前;血液中睾酮浓度均高于术前(均P<0.05),观察组患者术后HSP70,去甲肾上腺素均低于对照组,血液中睾酮浓度高于对照组,其差异均具有统计学意义(均P<0.05)。观察组患者并发症率4.9%低于对照组患者的19.5%,其差异具有统计学意义(P<0.05)。两组患者术后随访6～10个月,平均8个月,对照组3例(7.3%)复发,观察组无复发,其差异无统计学意义(P>0.05)。结论:显微镜下经外环下精索静脉结扎术治疗精索静脉曲张能显著改善患者精液质量,并降低HSP70,去甲肾上腺素的浓度,提高睾酮的浓度,具有较好的临床疗效。更多还原

【Abstract】 Objective: To analyze the effect of different surgical methods in the treatment of varicocele under microscope. Methods: 210 patients with infertility caused by varicocele in the Department of Urinary Surgery from April 2015 to April 2016 were selected,and 82 patients with left varicocele were randomly divided into 2 groups,with 41 cases in each group. The control group was given ligation of the spermatic vein via inguinal by microscope,and the observation group was given ligation of spermatic vein by microscope through inguinal ring. The operation time,hospitalization time,incision pain score,the quality of sperm before and after operation,the related molecular biological indexes,postoperative complications and follow-up of the two groups were observed and compared.Results: The operation time of observation group was significantly longer than that of control group,and the hospitalization time and incision pain score of observation group were significantly lower than those of control group,all with statistically significant differences( P < 0. 05). The sperm concentration,sperm motility and sperm activate rate of the two groups after operation were significantly improved( all P < 0. 05). The semen quality indexes of observation group were higher than those of control group( all P < 0. 05). Postoperative semen HSP70 and norepinephrine concentrations in serum of the two groups decreased,but the testosterone concentration in serum was higher than that before operation( all P < 0. 05). The postoperative HSP70 and norepinephrine of observation group were lower than those of control group,and the testosterone concentration in serum was higher than that of control group,with statistically significant differences( all P < 0. 05). The complication rate of observation group was 4. 9%,which was lower than that of control group of 19. 5%( P < 0. 05). The patients in the two groups were followed up for 6-10 months,an average of 8 months. There were 3 recurrence cases in control group( 7. 3%) and no recurrence case in observation group,without statistically significant differences( P > 0. 05). Conclusions: The treatment of varicocele by given ligation of spermatic vein with microscope through inguinal ring can significantly improve semen quality,reduce HSP70 and norepinephrine concentrations and increase testosterone concentration,withremarkable clinical curative effect.更多还原