腹腔镜保留睾丸动脉精索静脉高位结扎术对睾丸生精功能的影响

目的 探讨腹腔镜下精索内静脉高位结扎同时保留睾丸动脉治疗精索静脉曲张的应用价值.方法 选取156例精索静脉曲张患者,随机分成A、B两组:A组采用腹腔镜下保留睾丸动脉精索静脉高位结扎术,B组采用传统的Palomo术式.比较两组手术前后精液质量参数变化、术后并发症的发生率.结果 A组的手术时间为(32.24士8.35)min,明显短于B组(36.45士9.14)min (P＜0.05),术后阴囊水肿(2.67％)、附睾炎(4％)、睾丸萎缩率(2.67％)明显低于B组(P＜0.05),住院时间、术后复发率比较无统计学意义(P＞0.05)；术后精子计数[(43.00±4.3)×106]、精子活率[(65.00±4.55)％]明显高于B组[(37.20士5.45)×106]、[(53.34±6.73)％](P＜0.05),精子密度、精子活力分级比较差异无显著性(P＞0.05).结论 保留睾丸动脉腹腔镜精索内静脉高位结扎术能够明显提高术后精液参数质量,降低阴囊水肿、附睾炎、睾丸萎缩的发生率.

Effect of laparoscopic high ligation of spermatic vein on the function of testicular sperm production

Objective To explore the significance of laparoscopic high ligation of spermatic vein in keeping the testicular arteries for the treatment of varicocele.MethodsA total of 156 patients with varicocele were randomly divided into group A and B. Patients in group A received laparoscopic high ligation of spermatic vein to reserve the testicular arteries and patients in group B received traditional Palomo operation. The semen quality parameters before and after surgery, and the incidence of postoperative complications of the two groups were compared.ResultsThe surgery time of group A was （32.24± 8.35）min, which was significantly shorter than that of group B ［（36.45±9.14）min, P＜005］. The rates of postoperative scrotum edema （2.67%）, epididymitis （4%）, and testis atrophy （2.67%） of group A were lower than those of group B （P＜0.05）. There was no statistical difference in hospital stay and postoperative recurrence rate （P＞0.05）. The postoperative sperm count and live sperm rate of group A were （43.00＋4.3）× 106 and （65.00＋4.55）%, which were significantly higher than those of group B （P＜0.05）. There was no difference in sperm density and sperm vitality between the two groups （P＞0.05）.ConclusionReserving testicular arteries in laparoscopic high ligation of spermatic vein can significantly improve the quality of postoperative semen parameters, reducing the incidence of scrotal edema, epididymitis, and testicular atrophy.