【摘要】 目的 对比不同入路显微镜下精索静脉结扎术针对精索静脉曲张(VC)的临床疗效。方法 本研究将2021年1月至2023年5月于郑州大学第一附属医院接受显微镜下精索静脉结扎术治疗的100例VC患者纳入分析，其中对照组(50例)采用腹股沟下入路术式；观察组(50例)采用经外环下入路术式，两组均完成术后6个月随访。回顾性收集和分析患者的资料，包括围手术期指标、精液质量参数、性激素水平[促卵泡生成激素(FSH)、睾酮(T)、黄体生成素(LH)]、术后2周内并发症、术后6个月随访期间VC复发情况。结果 与对照组比较，观察组手术时间长(P<0.05)。两组术中出血量、术后排气时间比较，差异无统计学意义(P>0.05)。术后6个月时，两组精液质量均提高，且相比于对照组，观察组各项质量参数水平均高(P<0.05);两组血清FSH、LH水平降低，血清T水平升高，且相比于对照组，观察组血清FSH、LH水平低，T水平高(P<0.05);相比于对照组，观察组术后并发症总发生率低(P<0.05)。随访期间，两组均无复发病例。结论 与显微镜下腹股沟下精索静脉结扎术相比，经外环下精索静脉结扎术治疗VC的耗时虽长，但对精液质量的改善效果更好，更利于术后性激素水平的恢复，且患者术后并发症发生率低，安全性相对更理想。更多还原

【Abstract】 Objective To compare the clinical efficacy of varicocele(VC) treated with different approaches of varicocele ligation under microscope. Methods This study included 100 VC patients who underwent microsurgical varicocele ligation treatment at the First Affiliated Hospital of Zhengzhou University from January 2021 to May 2023. The control group(50 cases) underwent inguinal approach surgery, the observation group(50 cases) underwent surgery through the outer ring approach, and both groups completed a 6-month follow-up after surgery. The data of the patients were retrospectively collected and analyzed, including perioperative indicators, semen quality parameters, sex hormone levels [follicle-stimulating hormone(FSH), testosterone(T), luteinizing hormone(LH)], complications within 2 weeks after the operation, and the recurrence of VC during the 6-month follow-up period after the operation. Results Compared with the control group, the observation group had a longer surgical time(P<0.05). There was no statistical significant difference in intraoperative bleeding and postoperative exhaust time between the two groups(P>0.05). At 6 months after surgery, both groups showed an improvement in semen quality, and compared to the control group, the observation group had higher levels of various quality parameters(P<0.05). The levels of serum FSH and LH decreased in both groups, while the level of serum T increased. Compared with the control group, the observation group had lower levels of serum FSH and LH and higher levels of T(P<0.05). Compared to the control group, the observation group had a lower overall incidence of postoperative complications(P<0.05). During the follow-up period, there were no cases of recurrence in both groups. Conclusion Compared with microsurgical inguinal varicocele ligation, external ring varicocele ligation has a longer treatment time for VC, but it has a better improvement effect on semen quality and is more conducive to the recovery of postoperative sex hormone levels. In addition, the incidence of postoperative complications in patients is low, and the safety is relatively ideal.更多还原