腹腔镜下2种精索内静脉高位结扎术式的临床效果比较

发布时间：2018-06-14 14:54

  本文选题：腹腔镜手术 + 精索静脉曲张　； 参考：《中国微创外科杂志》2017年06期

【摘要】：目的探讨腹腔镜下精索血管集束高位结扎和腹腔镜下保留睾丸动脉精索内静脉高位结扎术治疗精索静脉曲张的术后精液参数变化及并发症。方法回顾性分析2012年9月~2015年3月我院行腹腔镜精索静脉高位结扎术的精索静脉曲张94例资料,其中腹腔镜精索血管集束高位结扎术45例(A组),腹腔镜下保留睾丸动脉精索内静脉高位结扎术49例(B组),比较2组术后6个月精液参数的变化以及术后并发症。结果术后随访8~56个月,平均26个月。术后6个月A、B组精液质量较术前均有明显改善,且术后精子数量[(35.9±2.1)×10~6vs.(44.9±2.3)×10~6,t=-19.541,P=0.000],精子密度[(25.6±2.1)×10~6/ml vs.(28.1±2.9)×10~6/ml,t=-4.874,P=0.000],精子活力(56.2%±3.3%vs.66.9%±4.0%,t=-14.124,P=0.000),B组明显好于A组。术后阴囊水肿[20.0%(9/45)vs.6.1%(3/49),χ~2=4.057,P=0.044],继发性鞘膜积液[17.8%(8/45)vs.4.1%(2/49),χ~2=4.629,P=0.031],附睾炎[24.4%(11/45)vs.6.1%(3/49),χ~2=6.212,P=0.013],睾丸萎缩[8.9%(4/45)vs.0%(0/49),Fisher检验,P=0.049],术后总并发症[73.3%(33/45)vs.20.4%(10/49),χ~2=26.674,P=0.000],A组均明显高于B组;2组术后精索静脉曲张复发率[2.2%(1/45)vs.4.1%(2/49),χ~2=0.262,P=0.608]无明显差异。术后自然妊娠率[40.0%(18/45)vs.73.5%(36/49),χ~2=10.749,P=0.001],B组明显高于A组。结论术中保留睾丸动脉有益于提高精液质量和自然妊娠率,减少术后睾丸萎缩、附睾炎、阴囊水肿。
[Abstract]:Objective to investigate the changes of semen parameters and complications in the treatment of varicocele by laparoscopic high ligation of spermatic vessels and high ligation of testicular artery. Methods from September 2012 to March 2015, 94 cases of varicocele underwent laparoscopic varicocele ligation in our hospital were retrospectively analyzed. There were 45 cases of group A with high ligation of spermatic cord and 49 cases of group B with high ligation of testicular artery. The semen parameters and complications were compared 6 months after operation in group 2. Results the follow-up was 8 ~ 56 months (mean 26 months). At 6 months after operation, the semen quality of group A was significantly improved than that of before operation, and the sperm quantity [35.9 卤2.1) 脳 10~6vs.(44.9 卤2.3) 脳 10 ~ (-6) ~ (-19.541) P ~ (0.000), sperm density [25.6 卤2.1) 脳 10~6/ml vs.(28.1 卤2.9) 脳 106ml ~ (-4.874) P _ (0.000), sperm motility 56.2% 卤3.3vs.66.9% 卤4.0 ~ (-1) P 0.000 in group B were significantly better than those in group A. 鏈�鍚庨槾鍥婃按鑲縖20.0%(9/45)vs.6.1%(3/49),蠂~2=4.057,P=0.044],缁у彂鎬ч灅鑶滅Н娑瞇17.8%(8/45)vs.4.1%(2/49),蠂~2=4.629,P=0.031],闄勭澗鐐嶽24.4%(11/45)vs.6.1%(3/49),蠂~2=6.212,P=0.013],鐫句父钀庣缉[8.9%(4/45)vs.0%(0/49),Fisher妫，

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