精索静脉显微结扎术与传统手术方式治疗原发性精索静脉曲张的疗效比较

Comparison of therapeutic effect between microsurgical varicocelectomy and conventional methods in the treatment of primary varicocele

摘要:

目的：比较3种手术方式治疗原发性精索静脉曲张的治疗效果。方法：将97例原发性精索静脉曲张患者根据手术方式随机分为3组：经腹股沟精索静脉高位结扎组（开放手术组）38例；腹腔镜下精索静脉高位结扎组（腹腔镜组）33例；显微镜下精索静脉结扎组（显微镜组）26例，术后随访12月，对比分析3组患者的手术治疗近期效果及并发症。结果：开放手术组、腹腔镜组、显微镜组3组手术均顺利完成。3组间手术时间比较（56.02±4.84 vs. 35.60±4.54 vs. 91.65±4.56，F=1 058.74，P=0.000），显微镜组最长；3组间动脉识别率比较（52.63% vs. 54.55%，P=0.872；54.55% vs. 100%，P=0.000；52.63% vs. 100%，P=0.000），显微镜组最高；3组间精液质量改善率比较（34.21% vs. 33.33%，P=0.938；33.33% vs. 65.38%，P=0.014；34.21% vs. 65.38%，P=0.014），显微镜组最高；术后切口疼痛评分比较（7.45±0.65 vs. 4.82±0.58 vs. 1.04±0.34，F=1 018.35，P=0.000），显微镜组最低；睾丸鞘膜积液发生率比较（26.32% vs. 21.21%，P=0.615；21.21% vs. 0，P=0.014；26.32% vs. 0，P=0.013），显微镜组最低；精索静脉曲张复发率比较（28.95% vs. 21.21%，P=0.455；21.21% vs. 0，P=0.014；28.95% vs. 0，P=0.007），显微镜组最低；住院时间比较（7.26±0.79 vs. 5.45±0.75 vs. 3.65±0.63，F=186.10，P=0.000），显微镜组最短。结论：除手术时间较长外，显微镜下精索静脉结扎术具有动脉识别率高，疗效好，并发症少，住院时间短等优势，值得临床应用。

Abstract:

Objective：To compare the therapeutic effect of three kinds of surgical treatments for primary varicocele． Methods：Ninety-seven patients with primary varicocele were randomly divided into three groups according to the operative methods：38 cases with high ligation of varicocele through an inguinal incision（open surgery group），33 cases with laparoscopic varicocelectomy（laparoscope group），26 cases with microsurgical varicocelectomy（microsurgery group）. All cases were followed up for 12 months. Therapeutic effects and complications of three groups were compared and analyzed． Results：All operations in three groups were completed successfully． There were significant differences in operating time among three groups（56.02±4.84 vs. 35.60±4.54 vs. 91.65±4.56，F=1 058.74，P=0.000）. There were significant differences in the identification rates of testis artery among three groups（52.63% vs. 54.55%，P=0.872；54.55% vs. 100%，P=0.000；52.63% vs. 100%，P=0.000）. There were significant differences in the improved quality of semen after the operation among three groups（34.21% vs. 33.33%，P=0.938；33.33% vs. 65.38%，P=0.014；34.21% vs. 65.38%，P=0.014）. There were significant differences in pain score of incision after the operation among three groups（7.45±0.65 vs. 4.82±0.58 vs. 1.04±0.34，F=1 018.35，P=0.000）. There were significant differences in the incidences of testicular hydrocele after the operation among three groups（26.32% vs. 21.21%，P=0.615；21.21% vs. 0.00%，P=0.014；26.32% vs. 0.00%，P=0.013）. There were significant difference in recurrence rate of varicocele after the operation among three groups（28.95% vs. 21.21%，P=0.455；21.21% vs. 0.00%，P=0.014；28.95% vs. 0.00%，P=0.007）. There were significant difference in the postoperative hospitalization duration among three groups（7.26±0.79 vs. 5.45±0.75 vs. 3.65±0.63，F=186.10，P=0.000）. Conclusion：With the advantages of higher identification rates of testis artery，satisfied efficacy，fewer complications and shorter hospitalization duration，microsurgical varicocelectomy is worth of clinical application expect longer operation time.