显微镜下经腹膜后精索静脉高位结扎与显微镜下经外环口精索静脉结扎的临床效果观察
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摘要
目的:评价显微镜下经腹膜后精索静脉高位结扎术与显微镜下经外环口精索静脉结扎术治疗精索静脉曲张的临床效果。方法:纳入本院2012年6月-2017年1月收治的132例精索静脉曲张患者,根据手术治疗方式的不同分为观察组(n=89)与对照组(n=43),观察组患者的手术方式为显微镜下经腹膜后精索静脉高位结扎术,对照组患者的手术方式为显微镜下经外环口精索静脉结扎术,观察两组患者的并发症发生率、术中出血量、复发率、手术时间与精液质量改善状况。结果:观察组患者的手术时间明显短于对照组,差异有统计学意义(P<0.05)。两组患者的术中出血量比较,差异无统计学意义(P>0.05)。术后3个月复查精液,两组的精液质量比较,差异无统计学意义(P>0.05)。术后对两组患者进行为期6个月的随访,观察组患者的曲张复发率明显高于对照组,差异有统计学意义(P<0.05);两组的并发症发生率比较,差异无统计学意义(P>0.05)。结论:显微镜下经腹膜后精索静脉高位结扎术时间更短,显微镜下经外环口精索静脉结扎术复发率更低,两种方法近远期疗效均较好,安全性高,具备临床推广价值。
Objective:To evaluate the clinical effect of high ligation of retroperitoneal spermatic vein under microscope and ligation of external spermatic vein under microscope in the treatment of varicocele.Method:A total of 132 patients with varicocele were enrolled in our hospital from June 2012 to January 2017,they were divided into observation group(n=89) and control group(n=43) according to the different surgical treatment methods,the operation mode of the observation group was high ligation of retroperitoneal spermatic vein under microscope,the operation of the control group was performed by ligation of the external spermatic vein under the microscope,the complication rate,blood loss,recurrence rate,operation time and semen quality improvement were observed in the two groups.Result:The operation time of the observation group was significantly shorter than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The semen was rechecked 3 months after operation,there was no significant difference in semen quality between the two groups(P>0.05).The patients in the two groups were followed up for 6 months after the operation,the recurrence rate of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Under the microscope by internal spermatic vein ligation in a shorter time,under the microscope through the outer ring ligation of varicocele recurrence rate is lower,short-term and long-term effects of the two methods are good, high safety,has clinical value.
Objective:To evaluate the clinical effect of high ligation of retroperitoneal spermatic vein under microscope and ligation of external spermatic vein under microscope in the treatment of varicocele.Method:A total of 132 patients with varicocele were enrolled in our hospital from June 2012 to January 2017,they were divided into observation group(n=89) and control group(n=43) according to the different surgical treatment methods,the operation mode of the observation group was high ligation of retroperitoneal spermatic vein under microscope,the operation of the control group was performed by ligation of the external spermatic vein under the microscope,the complication rate,blood loss,recurrence rate,operation time and semen quality improvement were observed in the two groups.Result:The operation time of the observation group was significantly shorter than that of the control group,the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The semen was rechecked 3 months after operation,there was no significant difference in semen quality between the two groups(P>0.05).The patients in the two groups were followed up for 6 months after the operation,the recurrence rate of the observation group was higher than that of the control group,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Under the microscope by internal spermatic vein ligation in a shorter time,under the microscope through the outer ring ligation of varicocele recurrence rate is lower,short-term and long-term effects of the two methods are good, high safety,has clinical value.
引文
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[13]黄多斌,冼杰,王君勇,等.显微术式与腹膜后精索静脉高位结扎术式治疗精索静脉曲张的效果对比[J].中国当代医药,2017,24(7):85-87.
[14]邓广鹏.腹股沟外环下显微镜结扎手术治疗腹腔镜精索静脉高位结扎术后精索静脉曲张复发的临床效果[J].中国当代医药,2015,22(5):42-43.
[15]武小强,闫天中,张祥生,等.经外环口下精索静脉曲张结扎术疗效分析[J].河南医学高等专科学校学报,2014,26(4):386-387.
[16]Ozturk U,Ozdemir E,Buyukkagnici U,et al.Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading[J].Andrologia,2012,44(Suppl 1):199-204.
[17]Najari B B,Li P S,Ramasamy R,et al.Microsurgical rat varicocele model[J].Journal of Urology,2014,191(2):548-553.
[18]Aldemir M,I??k E,Ozgün G,et al.Comparison of spermatic vein histology in patients with and without varicocele[J].Andrologia,2011,43(5):341-345.
[19]Mohseni M J,Nazari H,Amini E,et al.Shunt-type and stoptype varicocele in adolescents:prognostic value of these two different hemodynamic patterns[J].Fertility&Sterility,2011,96(5):1091-1096.
[20]Wong Y S,Chung K L,Lo K W,et al.Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric,adolescent and young adult varicoceles[J].Pediatric Surgery International,2014,30(1):107-111.
[2]Redmon J B,Carey P,Pryor J L.Varicocele-the most common cause of male factor infertility[J].Human Reproduction Update,2002,8(1):53-58.
[3]Franco G,Misuraca L,Ciletti M,et al.Surgery of male infertility:an update[J].Sexologies,2014,17(8):S16-S17.
[4]Diegidio P,Jhaveri J K,Ghannam S,et al.Review of current varicocelectomy techniques and their outcomes[J].Bju International,2011,108(7):1157-1172.
[5]Ficarra V,Crestani A,Novara G,et al.Varicocele repair for infertility:what is the evidence[J].Current Opinion in Urology,2012,22(6):489-494.
[6]Cho K S,Seo J T.Effect of Varicocelectomy on Male Infertility[J].Korean Journal of Urology,2014,55(11):703-709.
[7]Wong J,Chan S,Pagala M,et al.Lymphatic sparing microscopic retroperitoneal varicocelectomy:a preliminary experience[J].Journal of Urology,2009,182(5):2460-2463.
[8]Marte A,Pintozzi L,Cavaiuolo S,et al.Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents:Comparison between two techniques[J].African Journal of Paediatric Surgery,2014,11(3):201-205.
[9]Bansal D,Riachy E,Jr D W,et al.Pediatric varicocelectomy:a comparative study of conventional laparoscopic and laparoendoscopic single-site approaches[J].Journal of Endourology,2014,28(5):513-516.
[10]Hopps C V,Lemer M L,Schlegel P N,et al.Intraoperative varicocele anatomy:a microscopic study of the inguinal versus subinguinal approach[J].Journal of Urology,2003,170(6):2366-2370.
[11]Borruto F A,Impellizzeri P,Antonuccio P,et al.Laparoscopic vs open varicocelectomy in children and adolescents:review of the recent literature and meta-analysis[J].Journal of Pediatric Surgery,2010,45(12):2464-2469.
[12]Ding H,Tian J,Du W,et al.Open non-microsurgical,laparoscopic or open microsurgical varicocelectomy for male infertility:a meta-analysis of randomized controlled trials[J].Bju Interhational,2012,110(10):1536-1542.
[13]黄多斌,冼杰,王君勇,等.显微术式与腹膜后精索静脉高位结扎术式治疗精索静脉曲张的效果对比[J].中国当代医药,2017,24(7):85-87.
[14]邓广鹏.腹股沟外环下显微镜结扎手术治疗腹腔镜精索静脉高位结扎术后精索静脉曲张复发的临床效果[J].中国当代医药,2015,22(5):42-43.
[15]武小强,闫天中,张祥生,等.经外环口下精索静脉曲张结扎术疗效分析[J].河南医学高等专科学校学报,2014,26(4):386-387.
[16]Ozturk U,Ozdemir E,Buyukkagnici U,et al.Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading[J].Andrologia,2012,44(Suppl 1):199-204.
[17]Najari B B,Li P S,Ramasamy R,et al.Microsurgical rat varicocele model[J].Journal of Urology,2014,191(2):548-553.
[18]Aldemir M,I??k E,Ozgün G,et al.Comparison of spermatic vein histology in patients with and without varicocele[J].Andrologia,2011,43(5):341-345.
[19]Mohseni M J,Nazari H,Amini E,et al.Shunt-type and stoptype varicocele in adolescents:prognostic value of these two different hemodynamic patterns[J].Fertility&Sterility,2011,96(5):1091-1096.
[20]Wong Y S,Chung K L,Lo K W,et al.Scrotal antegradesclerotherapy demonstrates anatomical variations on venous drainage in paediatric,adolescent and young adult varicoceles[J].Pediatric Surgery International,2014,30(1):107-111.