显微镜下精索静脉结扎术对精索静脉曲张患者手术时间、睾酮水平及精子质量的影响

目的探究显微镜下精索静脉结扎术对精索静脉曲张患者手术时间、睾酮水平及精子质量的影响。方法前瞻性选取2014年2月至2019年10月四川省阆中市人民医院收治的精索静脉曲张患者103例,采用随机对照实验设计,以随机数字表法分为观察组(n=52)与对照组(n=51)。对照组采用腹腔镜下精索静脉结扎术,观察组采用显微镜下精索静脉结扎术。对比2组患者手术时间、术中出血量、住院时间、并发症、复发率、术前和术后6个月睾酮水平及精子质量。结果观察组手术时间长于对照组(48.23±6.55)min vs.(39.76±8.64)min],住院时间短于对照组(3.34±1.12)d vs.(3.92±0.80)d],差异有统计学意义(P<0.05),2组患者术中出血量比较(16.54±3.65)mL vs.(17.46±5.83)mL],差异无统计学意义(P>0.05)。观察组总并发症发生率低于对照组(5.77%vs.27.45%),差异有统计学意义(P<0.05)。观察组复发率低于对照组(1.92%vs.13.72%),但差异无统计学意义(P>0.05)。术后6个月,2组患者睾酮水平均较术前升高,观察组高于对照组(10.16±1.73)nmol/L vs.(8.26±1.39)nmol/L],差异有统计学意义(P<0.05)。术后6个月2组患者精子密度(112.43±15.79)、(109.52±12.76)×106/mL]、(a+b)级精子(62.29±9.42)%、(60.48±7.06)%]、精子存活率(71.02±10.46)%、(68.46±9.25)%]均较术前升高(P<0.05),组间比较差异无统计学意义(P>0.05)。结论精索静脉曲张患者应用显微镜下精索静脉结扎术可提高其睾酮水平及精子质量,减少并发症与复发率,但手术时间相对较长。

The effect of microscopically ligation of spermatic vein on operative time,testosterone level and sperm quality in patients with varicocele

Objective To explore the effect of microscopically ligation of spermatic vein on the operative time,testosterone level and sperm quality of patients with varicocele. Methods One hundred and three patients with varicocele in People’s Hospital of Langzhong City were selected as the research objects from February 2014 to October 2019,the patients were divided into observation group(n = 52) and control group(n = 51) by the method of random number table. The control group was treated with laparoscopic varicocele ligation,and the observation group was treated with microscopically ligation of spermatic vein,the operation time,intraoperative hemorrhage,hospitalization time,complications,recurrence rate,before and 6 months after surgery testosterone level and sperm quality were compared between the two groups. Results The operation time of the observation group was longer than that of the control group (48. 23 ± 6. 55) min vs.(39. 76 ± 8. 64) min],and the hospital stay was shorter than that of the control group (3. 34 ± 1. 12) d vs.(3. 92 ± 0. 80) d],the difference was statistically significant(P < 0. 05),and the intraoperative blood loss between the two groups was compared (16. 54 ± 3. 65) m L vs.(17. 46 ± 5. 83) m L],the difference was not statistically significant(P > 0. 05). The total complication rate of the observation group was lower than that of the control group(5. 77% vs. 27. 45%),the difference was statistically significant(P < 0. 05). The recurrence rate in the observation group was lower than that in the control group(1. 92%vs. 13. 72%),but the difference was not statistically significant(P > 0. 05). After operation,the level of testosterone in the two groups was higher than that before operation,and the observation group was higher than that in the control group(10. 16 ± 1. 73) nmol/L vs.(8. 26 ±1. 39) nmol/L](P < 0. 05). Six months after surgery,sperm density(112. 43 ± 15. 79),(109. 52 ± 12. 76) × 106/m L],(a + b) grade sperm(62. 29 ± 9. 42) %,(60. 48 ± 7. 06) % ],the survival rate of sperm(71. 02 ± 10. 46) %,(68. 46 ± 9. 25) %]was higher than that before operation(P < 0. 05),and there was no significant difference between the two groups(P > 0. 05). Conclusion Microscopically ligation of spermatic vein can improve the level of testosterone and sperm quality in patients with varicocele,reduce complications and recurrence rate,but the operation time is relatively long.