【摘要】：目的:精索靜脈曲張患者在分別接受顯微鏡外科手術(shù)和腹腔鏡手術(shù)兩種不同的術(shù)式治療后,回顧性分析他們在術(shù)前及術(shù)后精液質(zhì)量改變情況、術(shù)后并發(fā)癥的發(fā)生率、精索靜脈曲張復(fù)發(fā)以及不育患者的配偶懷孕率等方面的差異,對比2種手術(shù)方式的治療效果,為今后治療精索靜脈曲張的手術(shù)方式選擇提供參考。方法:選取2015年6月至2016年6月于我院男性科就診的Ⅱ度及Ⅲ度原發(fā)性精索靜脈曲張患者共90名,年齡17-36歲,平均年齡(26.95±3.39)歲。按手術(shù)方式分為A組:腹腔鏡精索靜脈結(jié)扎組和B組:顯微外科精索靜脈結(jié)扎組,每組均有45例。所有患者術(shù)前、術(shù)后1月、術(shù)后3月及術(shù)后6月均行精液分析檢查,觀察精子密度、精子總數(shù)、a+b級精子比例等精液質(zhì)量參數(shù)變化,術(shù)后隨訪患者是否出現(xiàn)術(shù)后并發(fā)癥、是否有復(fù)發(fā)、配偶是否懷孕等,將所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.兩組在術(shù)后不同時(shí)間點(diǎn)的精子密度差異均無統(tǒng)計(jì)學(xué)意義(F1=0.400、P1=0.528;F2=0.170、P2=0.681;F3=0.140、P3=0.906),術(shù)前精子密度與術(shù)后6個(gè)月相比較,A組精子密度的提高程度與B組精子密度提高程度相比,差別無統(tǒng)計(jì)學(xué)意義(F=0.078,P=0.781)。2.兩組術(shù)后不同時(shí)間點(diǎn)的精子總數(shù)差異均無統(tǒng)計(jì)學(xué)意義(F1=0.950、P1=0.332;F2=1.251、P2=0.266;F3=1.375、P3=0.244)。術(shù)前精子總數(shù)與術(shù)后6個(gè)月相比較,A組精子總數(shù)提高程度與B組精子總數(shù)提高程度相比,差別無統(tǒng)計(jì)學(xué)意義(F=1.342,P=0.250)3.兩組術(shù)后不同時(shí)間點(diǎn)a+b級精子比例差異均無統(tǒng)計(jì)學(xué)意義(F1=0.697、P1=0.406;F2=0.162、P2=0.689;F3=0.800、P3=0.373)。術(shù)前a+b級精子比例與術(shù)后6個(gè)月相比較,A組a+b級精子比例提高程度與B組a+b級精子比例提高程度相比,差別無統(tǒng)計(jì)學(xué)意義(F=2.281,P=0.135)4.術(shù)后1月至6月復(fù)診,A組出現(xiàn)鞘膜積液、陰囊腫脹的患者共10例,復(fù)發(fā)5例;而B組術(shù)后僅出現(xiàn)陰囊腫脹1例,無精索靜脈曲張復(fù)發(fā)的病例,差異有統(tǒng)計(jì)學(xué)意義(χ21=8.389、χ22=5.294,P1=0.004、P2=0.021)。術(shù)后隨訪1年兩組中因不育就診的患者配偶懷孕率分別為A組6/34(17.65%),B組14/33(42.42%),差異有統(tǒng)計(jì)學(xué)意義(χ2=4.910,P=0.027)5.A組術(shù)后禁食時(shí)間平均為(22.96±1.68)h,B組平均為(5.40±0.81)h,A組較B組術(shù)后禁食時(shí)間明顯增加,差異具有統(tǒng)計(jì)學(xué)意義(F=13.624,P=0.000);A組術(shù)后住院天數(shù)平均為(4.38±0.49)天,B組平均為(1.24±0.35),A組較B組術(shù)后住院天數(shù)明顯延長,差異具有統(tǒng)計(jì)學(xué)意義(F=7.168,P=0.009)。結(jié)論:1.顯微外科手術(shù)和腹腔鏡手術(shù)均可有效提高患者精液質(zhì)量,提示對于引起精液質(zhì)量異常的精索靜脈曲張患者應(yīng)積極外科治療。2.在精索靜脈曲張治療過程中顯微外科手術(shù)能夠更好地減少術(shù)后并發(fā)癥的發(fā)生,同時(shí)降低術(shù)后復(fù)發(fā)率。3.顯微外科手術(shù)還具有手術(shù)創(chuàng)傷小、配偶懷孕率高、不影響美觀等優(yōu)勢,值得在臨床上推廣。4.顯微外科手術(shù)的患者術(shù)后住院天數(shù)少、禁食時(shí)間短,更加符合加速康復(fù)外科的治療理念。
[Abstract]:Objective: to analyze the changes of semen quality, the incidence of postoperative complications, the recurrence of varicocele and the pregnancy rate of infertile patients before and after microscopic surgery and laparoscopic surgery, respectively, and to compare the therapeutic effects of the two methods. It provides a reference for the choice of surgical methods for the treatment of varicocele in the future. Methods: from June 2015 to June 2016, a total of 90 patients with primary varicocele of degree II and degree III were selected in our hospital. The average age was (26.95 鹵3.39) years. According to the operation method, they were divided into group A: laparoscopic spermatic vein ligature group and group B: microsurgical spermatic vein ligature group, with 45 cases in each group. All patients were examined by semen analysis before operation, 1 month after operation, 3 months after operation and 6 months after operation. The changes of semen quality parameters, such as sperm density, total sperm, a b sperm ratio, postoperative complications, recurrence, pregnancy and so on, were statistically analyzed. Result: 1. There was no significant difference in sperm density between the two groups at different time points after operation (F1: 0.400, P _ 1: 0.528 / F _ 2: 0.170, P _ 2: 0.681, P _ 3: 0.906). Compared with 6 months after operation, there was no significant difference in sperm density between group A and group B (F = 0.078, P = 0.781). There was no significant difference in the total sperm count between the two groups at different time points after operation (F1 0.950, P1 0.332 F2 1.251, P20.266F3 1.375, P3 0.244). Compared with 6 months after operation, there was no significant difference in the total sperm count between group A and group B (F 鈮，

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