经皮小切口腹膜外超选择性精索静脉结扎和腹腔镜手术治疗精索静脉曲张的临床随机对照研究

目的：比较经皮小切口腹膜外超选择性精索静脉结扎和腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的效果。方法：将884例精索静脉曲张患者分成两组，A组为经皮小切口腹膜外超选择性精索静脉结扎组，810例；B组为腹腔镜下精索静脉高位结扎组，74例；比较两组的手术时间、术后住院天数、住院费用、症状缓解率、并发症发生率和精液质量改善率等。结果：两组平均手术时间、术后住院天数相似，差异无统计学意义（P〉0．05）；A组住院费用比B组少，差异有统计学意义（P〈0．05）；A组复发率及睾丸鞘膜积液、阴囊水肿和附睾肿痛等术后并发症发生率低于B组，差异有统计学意义（P〈0．05）；两组术后6个月精液质量改善率相似，差异无统计学意义（P〉0．05）。结论：经皮小切口腹膜外超选择性精索静脉结扎术属于微创手术，较腹腔镜下精索静脉高位结扎术具有复发率低、并发症少、住院费用低、疗效好和易推广等优点。

Randomized Controlled Trail of Ectoperitoneal Ultra-selective High Spermaticl Vein Ligation via Minimal Skin Incision and Laparoscopic Varicocele Ligation

Objective：To evaluate the efficacy between ectoperitoneal ultra selective high spermatic vein ligation via minimal skin incision and laparoscopic varicocele ligation. Methods： 884 cases of varicocele were divided into 2 groups： 810 patients（group A） who underwent ectoperitoneal ultra-selective high spermatic vein ligation via minimal skin incision and 74 patients（group B） who underwent laparoscopic varicocele ligation were analyzed. To compare two operative methods on average operation time, mean post-operation hospital stay,medical expense of hospitalization, remission（CR） rate, incidence of complications, improvement rate of sperm. Results： No significant differences were found in average operation time and mean post operation hospital stay among the 2 groups（P〉 0.05）,while the medical expense of hospitalization in group A was lower than that in group B, and the difference was significant between 2 groups （P〈0.05）; the recurrence and the incidence of complications after operation （such as hydrocele, edema of scrotum, swelling and pain in epididymis and so on） in group A were lower than that in group B. there was no significant differences in improvement rate of sperm among the 2 groups（P〉0.05）. Conclusions： Ectoperitoneal ultra selective high spermatic vein ligation via minimal skin incision has advantages of lower recurrence, less complication, lower medical expense of hospitalization, satisfactory curative effect, easy to promote and micro invasion.