显微镜手术与腹腔镜手术治疗原发性精索静脉曲张的疗效比较

发布时间：2019-06-19 07:47

【摘要】：目的:精索静脉曲张患者在分别接受显微镜外科手术和腹腔镜手术两种不同的术式治疗后,回顾性分析他们在术前及术后精液质量改变情况、术后并发症的发生率、精索静脉曲张复发以及不育患者的配偶怀孕率等方面的差异,对比2种手术方式的治疗效果,为今后治疗精索静脉曲张的手术方式选择提供参考。方法:选取2015年6月至2016年6月于我院男性科就诊的Ⅱ度及Ⅲ度原发性精索静脉曲张患者共90名,年龄17-36岁,平均年龄(26.95±3.39)岁。按手术方式分为A组:腹腔镜精索静脉结扎组和B组:显微外科精索静脉结扎组,每组均有45例。所有患者术前、术后1月、术后3月及术后6月均行精液分析检查,观察精子密度、精子总数、a+b级精子比例等精液质量参数变化,术后随访患者是否出现术后并发症、是否有复发、配偶是否怀孕等,将所有数据进行统计学分析。结果:1.两组在术后不同时间点的精子密度差异均无统计学意义(F1=0.400、P1=0.528;F2=0.170、P2=0.681;F3=0.140、P3=0.906),术前精子密度与术后6个月相比较,A组精子密度的提高程度与B组精子密度提高程度相比,差别无统计学意义(F=0.078,P=0.781)。2.两组术后不同时间点的精子总数差异均无统计学意义(F1=0.950、P1=0.332;F2=1.251、P2=0.266;F3=1.375、P3=0.244)。术前精子总数与术后6个月相比较,A组精子总数提高程度与B组精子总数提高程度相比,差别无统计学意义(F=1.342,P=0.250)3.两组术后不同时间点a+b级精子比例差异均无统计学意义(F1=0.697、P1=0.406;F2=0.162、P2=0.689;F3=0.800、P3=0.373)。术前a+b级精子比例与术后6个月相比较,A组a+b级精子比例提高程度与B组a+b级精子比例提高程度相比,差别无统计学意义(F=2.281,P=0.135)4.术后1月至6月复诊,A组出现鞘膜积液、阴囊肿胀的患者共10例,复发5例;而B组术后仅出现阴囊肿胀1例,无精索静脉曲张复发的病例,差异有统计学意义(χ21=8.389、χ22=5.294,P1=0.004、P2=0.021)。术后随访1年两组中因不育就诊的患者配偶怀孕率分别为A组6/34(17.65%),B组14/33(42.42%),差异有统计学意义(χ2=4.910,P=0.027)5.A组术后禁食时间平均为(22.96±1.68)h,B组平均为(5.40±0.81)h,A组较B组术后禁食时间明显增加,差异具有统计学意义(F=13.624,P=0.000);A组术后住院天数平均为(4.38±0.49)天,B组平均为(1.24±0.35),A组较B组术后住院天数明显延长,差异具有统计学意义(F=7.168,P=0.009)。结论:1.显微外科手术和腹腔镜手术均可有效提高患者精液质量,提示对于引起精液质量异常的精索静脉曲张患者应积极外科治疗。2.在精索静脉曲张治疗过程中显微外科手术能够更好地减少术后并发症的发生,同时降低术后复发率。3.显微外科手术还具有手术创伤小、配偶怀孕率高、不影响美观等优势,值得在临床上推广。4.显微外科手术的患者术后住院天数少、禁食时间短,更加符合加速康复外科的治疗理念。
[Abstract]:Objective: to analyze the changes of semen quality, the incidence of postoperative complications, the recurrence of varicocele and the pregnancy rate of infertile patients before and after microscopic surgery and laparoscopic surgery, respectively, and to compare the therapeutic effects of the two methods. It provides a reference for the choice of surgical methods for the treatment of varicocele in the future. Methods: from June 2015 to June 2016, a total of 90 patients with primary varicocele of degree II and degree III were selected in our hospital. The average age was (26.95 卤3.39) years. According to the operation method, they were divided into group A: laparoscopic spermatic vein ligature group and group B: microsurgical spermatic vein ligature group, with 45 cases in each group. All patients were examined by semen analysis before operation, 1 month after operation, 3 months after operation and 6 months after operation. The changes of semen quality parameters, such as sperm density, total sperm, a b sperm ratio, postoperative complications, recurrence, pregnancy and so on, were statistically analyzed. Result: 1. There was no significant difference in sperm density between the two groups at different time points after operation (F1: 0.400, P _ 1: 0.528 / F _ 2: 0.170, P _ 2: 0.681, P _ 3: 0.906). Compared with 6 months after operation, there was no significant difference in sperm density between group A and group B (F = 0.078, P = 0.781). There was no significant difference in the total sperm count between the two groups at different time points after operation (F1 0.950, P1 0.332 F2 1.251, P20.266F3 1.375, P3 0.244). Compared with 6 months after operation, there was no significant difference in the total sperm count between group A and group B (F 鈮，

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