经皮小切口治疗精索静脉曲张两种术式的临床随机对照研究

目的观察比较两种经皮小切口腹膜外手术方式治疗精索静脉曲张的临床疗效。方法将2000年6月～2009年10月就诊的106例精索静脉曲张患者随机均分为两组：A组予以经皮小切口腹膜外精索血管高位集束结扎术。B组予经皮小切口腹膜外单纯精索内静脉高位结扎术。比较两组之间术后症状缓解率，近、远期并发症、复发率及术后精液改善情况等指标，比较其临床疗效。结果术后两组症状消失接近，但差异无统计学意义（P〉0．05）；两组均无出现近、远期并发症；B组术后复发5例（5／53，9．43％），明显高于A组，差异有统计学意义（P〈0．05）；两种手术方式术后精液质量均较术前明显提高（P〈0．05），但组间比较差异无统计学意义（P〉0．05）。结论两种手术方式治疗精索静脉曲张均有明显临床疗效．但经皮小切口腹膜外精索血管高位集束结扎术式因其术后复发率更少，且具有操作简便、治愈率高等优点，可作为手术治疗精索静脉曲张的首选。

The randomized controlled trail between two methods of via minimal skin incision for the treatment of spermatic varicocele

Objective To analyze and observe the curative effects between two methods of extraperitoneal via minimal skin incision for the treatment of spermatic varicocele.Methods From June 2000 to October 2009,106 examples were randomly divided into group A who underwent via minimal skin incision cluster ligation and group B who received via minimal skin incision high ligation of internal spermatic vein,and to analyze the early and long-term complications,the quality of semen and the rate of recurrence.Results There was no significant differences in improvement symptom between two groups(P > 0.05);The two groups were not appeared nearly,long-term complications;The recurrence rate in group B was obviously higher than group A,and the difference was significant between two groups(P < 0.05);The quality of semen in two group was all increased by comparing improvement rate of sperm before and after operation(P < 0.05),but no difference was found between two groups(P > 0.05).Conclusion Two methods of extraperitoneal via minimal skin incision for the treatment of spermatic varicocele is reliable effect,but method of extraperitoneal via minimal skin incision cluster ligation has the advantages of lower recurrence rate,simple operation and higher cure rate,can be regarded as the first method for treatment of varicocele.