摘要
目的对比分析不同精索静脉曲张手术的临床疗效。方法回顾性分析2012-2015年泌尿外科手术治疗的原发性精索静脉曲张患者261例临床资料,根据患者接受手术方式不同分为5组,分别为：腹腔镜A组（腹腔镜经腹精索静脉结扎术）,腹腔镜B组（腹腔镜腹膜外径路）,开放手术A组（改良后Palomo术）,开放手术B组（传统开放精索静脉高危结扎术）,介入栓塞组（逆行介入栓塞术）。统计5组手术时长、住院时长、术后并发症、术后配偶妊娠率以及术后精索静脉曲张的复发率,比较各组术前、术后精子质量。结果介入栓塞组手术耗时较长（P〈0.05）,但介入栓塞组住院时间较短（P〈0.05）,平均1.50±0.50 d;术后1年,介入栓塞组妊娠率最低,其他各组配偶妊娠率差异无显著性（P〉0.05）;术后各组精子浓度、低渗膨胀试验（HOS）比率以及精子向前运动（PR）百分率均明显高于手术前（P〈0.05）,术后各组间比较,差异无统计学意义（P〉0.05）;术后开放手术A组和B组复发率和并发症发生率均较高（P〈0.05）。腹腔镜A组、B组间复发率和并发症发生率无显著差异（P〉0.05）。介入栓塞组复发率明显高于其他组,并发症相对较少（P〈0.05）。结论治疗精索静脉曲张,腹腔镜手术时间短,并发症少,适宜手术量大的男科应用;介入栓塞术无手术刀疤,术后恢复最快,但复发率较高;开放性手术创伤较大,术后并发症较多,不推荐。
Objective To compare and analyze the curative effect of different varicocele operation. Methods Retrospective analysis was performed in 261 patients with varicocele,who received surgical treatment. We collected the relevant clinical data of these patients. According to different operation mode,all patients were divided into 5 groups,the laparoscopic group A（ laparoscopic abdominal spermatic vein ligation）,laparoscopic group B（ laparoscopic peritoneal diameter road）,open surgery group A（ modified Palomo）,open surgery group B（ traditional open ligation of spermatic vein high risk）,interventional embolization group（ retrograde interventional embolization）. The operation time,hospitalization duration,postoperative complications,postoperative spouse pregnancy rate and postoperative recurrence of varicocele of 5 groups were compared.The preoperative and postoperative sperm quality were compared. Results Surgical intervention group spent longer time（ P〈0. 05）,but the intervention group had shorter length of hospital stay（ P〈0. 05）,with an average of 0. 05 ± 0. 50 days. Pregnancy rate after 1 year postoperatively,interventional embolization group,other groups mate there was no significant difference of pregnancy rate（ P〉0. 05）. After the examination of each sperm concentration percentage,the percentage of HOS,and PR were significantly higher than that of before operation（ P〈0. 05）. There was no statistically significant difference among each group,（ P〉0. 05）. Postoperative recurrence rate and complication rates of open surgery group A and group B were higher（ P〈0. 05）,there was no significant difference between group A and group B（ P〉0. 05）. Recurrence of interventional embolization group was obviously higher than that of other groups,relatively few complications（ P〈0. 05）. Conclusion Laparoscopic surgical time is short,less complications. Male is suitable for large applications. Interventional embolization without surgical scar,recovery is the fastest,but the recurrence rate is higher. Open surgical trauma had more postoperative complications,which is not recommended.
出处
《临床和实验医学杂志》
2016年第10期1016-1020,共5页
Journal of Clinical and Experimental Medicine
