显微镜下三种手术入路治疗精索静脉曲张的探索

目的对比分析显微镜下三种手术入路治疗精索静脉曲张的临床效果。方法回顾性分析2017年3月至2019年2月于苏州大学附属第二医院行精索静脉结扎术的88例患者资料,所有患者均在显微镜下行精索静脉结扎术,手术由同一组医师完成。根据手术入路的不同分为三组,Ⅰ组经腹膜后切口(n=14),Ⅱ组经腹股沟切口(n=48),Ⅲ组经外环口下切口(n=26),比较三组患者的手术时间、结扎静脉数量、复发率、精液质量的改善情况、视觉模拟评分法(VAS)及术后短期并发症。结果Ⅲ组手术时间、结扎静脉分支数量明显多于Ⅱ组(P<0.05);三组患者术后精液质量均优于术前(P<0.05);术后VAS评分均低于术前评分(P<0.05)。但是,三组患者短期并发症的发生率、复发率、阴囊疼痛缓解程度、精子活力与形态改善情况进行组间比较,差异无统计学意义(P>0.05)。结论三种显微镜下精索静脉结扎术均能改善患者精液质量、缓解阴囊疼痛。临床上,应根据患者的实际情况选择合适的手术入路完成手术,以获得好的临床疗效。

Exploration of three surgical approaches under microscope for the treatment of varicocele

Objective To compare and analyze the clinical effects of three surgical approaches under the microscope in the treatment of varicocele.Methods The data of 88 patients with varicocele ligation in the Second Affiliated Hospital of Soochow University from March 2017 to February 2019 were analyzed retrospectively.All patients underwent microsurgical varicocele ligation.The operation was performed by the same team of surgeons.According to the different surgical approaches,the patients were divided into three groups.Group I(n=14)was retroperitoneal incision,group II(n=48)was incision through the inguinal region,and group III(n=26)was incision through the outer ring.The operation time,number of ligation veins,recurrence rate,improvement of semen quality,VAS score(visual analogue scale/score)and short-term postoperative complications were compared in the three groups.Results The operation time and the number of ligature vein branches in group III were significantly more than those in group II(P<0.05);the semen quality of the three groups after operation was better than that before operation(P<0.05);the postoperative VAS score was lower than the preoperative score(P<0.05).However,there was no significant difference of short-time complications,postoperative recurrence rate,relief of scrotal pain,sperm motility and morphological improvement among the three groups(P>0.05).Conclusion Microsurgical spermatic vein ligation can improve the quality of semen and relieve scrotal pain.Clinically,in order to obtain good clinical results,the appropriate surgical approach should be selected according to the actual situation of the patient to complete the operation.