改良外环下显微镜精索静脉结扎术的临床疗效观察

目的 探讨分析改良外环下显微镜精索静脉结扎术对精索静脉曲张的临床疗效.方法 回顾性分析本院2012年8月至2014年6月收治的精索静脉曲张患者112例,按照不同的手术方式分成腹股沟结扎组28例,腹腔镜组28例,腹股沟外环下显微镜组28例,改良外环下显微镜组(外环口纵向切开约1 cm)28例.对比分析各组的手术效果及术后并发症.结果 四组手术均顺利完成.应用显微镜的两组间手术时间无统计学差异(P＞0.05),但比腹股沟结扎组、腹腔镜组手术时间长(P＜0.05).显微镜两组间住院时间无统计学差异(P＞0.05),比腹股沟结扎组、腹腔镜组住院时间明显缩短(P＜0.05).根据术后疼痛(VAS)评分,显微镜的两组术后疼痛较轻(P＜0.05),且这两组组间比较无统计学差异.腹股沟外环下显微镜组与改良外环下显微镜组保留精索动脉数比较统计学有显著差异(P =0.001),改良外环下显微镜组遇到的动脉数更少.四组间术后并发症,显微镜两组较低(P＜0.05),而这两组组间比较无统计学差异(P＞0.05).四组的复发率分别为28.6％、10.7％、0％、0％(P＜0.05),显微镜的两组均无复发.术后四组的精液密度、精液活力都较术前得到改善,其中显微镜的两组改善更明显,这两组组间比较无统计学差异(P＞0.05).1年后自然怀孕率,四组间差异无统计学意义(P＞0.05).结论 显微镜治疗精索静脉曲张疗效好,并发症少,术后疼痛轻及住院时间短.同时改良外环下显微镜精索静脉结扎术更易于操作,是一种安全有效的手术方式.

Clinical observation of the modified microsurgery subinguinal varicocelectomy

Objectives To investigate the observation of the modified microsurgery subinguinal varicocelectomy.Methods A retrospective analysis of the 112 patients with varicocele in our hospital from August 2012 to June 2014 were performed.According the surgical methods,all patients were randomly divided into 4 groups:ingunal approach group,laparoscopic varicocelectomy group,microsurgical subinguinal varicocelectomy group and modified microsurgery subinguinal varicocelectomy group,28 cases of each group.The clinical effects and the complication were compared among 4 group.Results All operations in the four groups were completed successfully.The operative time of the two groups in which the microscope was used were not significantly different (P ＞ 0.05),but they were longer than that of the other groups (P ＜ 0.05).The length of stay between the microsurgical subinguinal varicocelectomy group and modified microsurgery subinguinal varicocelectomy group was not significantly different (P ＞ 0.05),but they were shorter than the other groups (P ＜ 0.05).The postoperative pain score of the two microscope's groups was lower than the others,and it was not significantly different between the two microscope's groups.Preservations of the arteries in the last two groups were significantly different (P =0.001),and the less number of arteries were countered in the modified microsurgery subinguinal varicocelectomy's group.The postoperative complication and the recur-rence of the last two groups were less than the others,and it was not significantly different between the last two groups.In the four groups,the average postoperative sperm value was significantly higher than the preoperative sperm value(P ＞ 0.05).The rates of natural pregnancy among the four groups were not statistically significant differences (P ＞ 0.05).Conclusions Microsurgery in the treatment of varicocele has advantages of good efficiency,low complications,less pain and short hospital stay.The modified microsurgery subinguinal varicocelectomy is easier to operate,it is a safe and effective procedure for the treatment of varicocele.