三种不同手术方式治疗精索静脉曲张的对比研究

目的：比较不同手术方式治疗精索静脉曲张（VC）的临床疗效、并发症及住院总费用。方法对180例原发性VC患者分别采用3种手术方法治疗，即A组（显微镜手术组）、B组（开放手术组）、C组（腹腔镜手术组）各60例。了解并比较3组患者的手术时间、睾丸动脉保留率、术中出血量、并发症发生率、术后住院时间、住院总费用及术后精液分析指标改善情况。结果 A组手术时间较B、C组长，但A组住院时间及住院总费用明显低于B、C组（均P＜0.05）。A组动脉保留率明显高于B、C组（P＜0.05）。3组术中出血量的差异无统计学意义（P＞0.05）。术后A组并发症发生率显著低于B、C组（P＜0.05），复发率及睾丸萎缩发生率与B、C组无统计学差异（均P＞0.05），术后半年精液分析指标改善情况明显好于B、C组（均P＜0.05）。结论3种手术方式治疗精索静脉曲张均有效、简便，但显微镜下精索静脉结扎术与开放手术和腹腔镜手术相比并发症更少、住院时间更短及住院总费用更低、术后恢复更快，更值得临床推广应用。

Comparison of three surgical modalities for treatment of varicocele

Objective To compare the application of microscopic, laparoscopic and open operations for treatment of varicocele. Methods One hundred and eighty patients with Ⅱ~Ⅲdegree primary varicocele underwent spermatic vein high ligation, with microscopic （group A, n=60）, laparoscopic （group B, n=60） or open （group C, n=60） approaches. The patients were fol owed up for 6- 24 months. The operation time, intraoperative blood loss, complications, postoperative hospitalization days, hospitalization expenses, recurrence and semen quality were compared among 3 groups. Results Al operations were complet-ed successful y with little blood loss. The operation time of group A was longer, but the postoperative hospitalization days and hospitalization expenses were less than those of groups B and C （P〈0.05）. There was no significant difference in average intra-operative blood loss among three groups （P＆gt;0.05）. The rate of complication of groups A, B and C was 1.7%（1/60）, 21.7%（13/60） and 16.7%（10/60）, respectively. The rate of reserved artery in groups A, B and was 100.0%, 88.3% and 81.7% respectively （groups A vs group B and C, P〈0.05）. No significant differences in the recurrence rate and testicular atrophy after operation were found among three groups （P＆gt;0.05）. The sperm amount, sperm density and sperm motility of three groups were increased 6 months after operation （P〈0.05）;while the rate of sperm quality improvement in group A was higher than that other two groups （P〈0.05）. Conclusion Al three surgical modalities of spermatic vein high ligation are effective for treatment of varicocele, but the microsurgical varicocelectomy is more effective with less expenses, lower complication and high semen quality than laparoscopic and open approaches.