腹腔镜与显微镜下治疗青年精索静脉曲张疗效分析

Comparison of the Outcomes of Laparoscopic Varicocelectomy and Microscopic Varicocelectomy in Adolescence

摘要: 目的：探讨腹腔镜与显微镜下治疗青年原发性精索静脉曲张的疗效、安全性。方法：回顾性分析71名青年原发性精索静脉曲张患者治疗后随访资料，其中有5例慢性前列腺炎患者。39例接受腹腔镜精索静脉高位结扎术(腹腔镜组)，2例慢性前列腺炎患者；32例接受显微镜下精索静脉结扎组(显微镜组)，3例慢性前列腺炎患者。比较两组患者术前、术后3月精液质量、激素水平、睾丸体积变化情况及手术时间、住院天数、费用。结果：两组患者手术均顺利完成，腹腔镜组与显微镜组相比手术时间明显缩短(85.94 ± 20.44 vs 39.00 ± 9.69, P < 0.05)，住院费用明显增高(4866 ± 541.45 vs 7820 ± 906.21, P < 0.05)，术后住院时间差异无统计学意义(P > 0.05)。两组患者术后精液质量较术前无差异(P > 0.05)，精子密度、精子存活率、A + B级精子明显改善，差异有统计学意义(P < 0.05)。显微镜组与腹腔镜组术后精子密度、精子存活率、A + B级精子相比差异无统计学意义(P > 0.05)。腹腔镜组术后2例(5.1%)复发，1例(2.6%)附睾炎，2例(5.1%)症状持续存在，2例(5.1%)阴囊水肿；显微镜组术后无复发、附睾炎、阴囊水肿，但是有1例(3.1%)患者症状持续存在。结论：青年精索静脉曲张患者精液质量大多已受影响，早期手术可以恢复精液质量或减轻精液质量的下降。腹腔镜与显微镜下治疗精索静脉曲张均为微创手术，创伤小、疗效好，但是显微镜下治疗精索静脉曲张费用低、术后复发率低、并发症更少。

Abstract: Objective: To compare curative effect between microscopic and laparoscopic approach for treatment of varicocele. Method: We retrospectively analyzed 71 adolescence varicocele patients after treatment follow-up data. 39 cases underwent laparoscopic high ligation of spermatic vein (laparoscopic group). 32 patients received ligation of varicocele group under the microscope (microscopy group). The semen quality, hormone levels and testicular volumes of these two groups of patients before and after the operation, operation time, hospitalization days and cost were compared. Results: All patients were successfully completed the operation. Laparoscopic group compared with microscope group operation time is obviously shortened (85.94 + 20.44VS39.00 + 9.69, P < 0.05). There was no statistically significant difference of postoperative hospital stay (P > 0.05), but the cost was significantly increased (4866 + 541.45VS7820 + 906.21, P < 0.05). Compared with preoperative semen quality, postoperative semen quality of these two groups of patients showed no statistical significance. Sperm density, sperm survival rate, A + B grade sperm significantly improved (P < 0.05). In the laparoscopic group after operation, 2 cases (5.1%) of recurrence, 1 case (2.6%) of patients with epididymitis; 2 cases (5.1%) clinical symptoms persisted and 2 cases (5.1%) occurred scrotal edema. However, no recurrence, epididymitis, scrotal edema in the microscope group after operation, but 1 case (3.1%) of patients with persistent symptoms. Conclusion: Most of the youth semen quality of patients with varicocele has affected; early operation can restore the semen quality or decrease the damage level of semen quality. Laparoscopic and microscope to treat varicocele were minimally invasive operation. They have the characteristics of small trauma, good curative effect, but the microsurgical operation has the advantages of low cost, lower postoperative recurrence rate and fewer complications characteristics.