外環下顯微外科精索靜脈結扎術對精索靜脈曲張患者精液質量的影響

符紅霞 梁培育 周治彥

【摘要】目的：探討外環下顯微外科精索靜脈結扎術對精索靜脈曲張患者精液質量的影響，并觀察和分析其安全性。方法：選擇本院2012年10月至2014年3月精索靜脈曲張患者104例，根據手術方法分為對照組51例和觀察組53例，對照組患者采用腹腔鏡下精索靜脈結扎術，觀察組患者采用外環下顯微外科精索靜脈結扎術。記錄兩組患者手術時間、出血量、術后住院天數，檢測治療前后精液質量及畸形率，觀察術后并發癥及復發狀況。結果：觀察組出血量和住院時間分別為（24.58±4.93）mL和（5.13±1.24）d，均低于對照組，差異有統計學意義（P<0.05）；觀察組患者治療后精子數量、精子活力和精子活動率分別為（43.76±7.22）×106/mL、（48.66±5.93）%和（55.28±7.50）%，均高于對照組治療后（34.53±5.28）×106/mL、（37.83±6.36）%和（52.15±7.12）%，差異具有統計學意義（P<0.05）。觀察組患者治療后精子畸形率為（12.42±3.86）%，低于對照組治療后（16.21±5.08）%，差異具有統計學意義（P<0.05）。觀察組患者不良反應及復發總計4例（7.55%），低于對照組10例（19.61%），差異具有統計學意義（P<0.05）。結論：外環下顯微鏡精索靜脈結扎術創傷小、恢復較快，能夠顯著提高患者精子數量和質量，術中可有效保護睪丸動脈及淋巴管，減少術后并發癥及復發率。

【關鍵詞】顯微外科；精索靜脈結扎術；精索靜脈曲張；精液質量

Impact on semen quality of varicocele patients with spermatic vein ligation under the outer ring microsurgeryFU Hongxia， LIANG Peiyu， ZHOU Zhiyan. Department of Urology，The Hospital Affiliated to Hainan Medical University， Haikou 570102， Hainan， China

【Abstract】Objectives： To explore the impact on semen quality of varicocele patients with spermatic vein ligation under the outer ring microsurgery， and to observe and analyze its security. Methods： 104 varicocele patients were selected in the hospital from October in 2012 to March in 2014 and according to the operation method， were divided into the control group （51 cases） and the observation group （53 cases）. The control group was treated by laparoscopic ligation of spermatic vein， while the observation group was treated by microsurgery under the outer ring ligation of spermatic vein. The operation time， blood loss， postoperative hospitalization time of two groups was recorded； the semen quality and malformation rate before and after the treatment was detected； the postoperative complications and recurrence was observed. Results： The blood loss and hospitalization time of the observation group respectively were （24.58±4.93） ml and （5.13±1.24） d， lower than the control group， with statistically significant difference （P<0.05）. The sperm amount， sperm motility and sperm activity respectively of the observation group after treatment were （43.76±7.22）×106/ml， （48.66±5.93） % and （55.28±7.50） %， higher than the control group （34.53±5.28）×106/ml， （37.83±6.36） % and （52.15±7.12） %， with statistically significant difference （P<0.05）. The sperm malformation rate of the observation group after treatment was （12.42±3.86） %， lower than the control group （16.21±5.08） %， with statistically significant difference （P<0.05）. The total adverse reaction and recurrence in the observation group were 4 cases and 7.55%， lower than the control group （10 cases， 19.61%）， with statistically significant difference （P<0.05）. Conclusions： For outer ring ligation of spermatic vein under the microscope， it causes little injury and pain with rapid recovery， which can also significantly improve the sperm count and quality. During the operation it can effectively protect the testicular artery and lymphatic vessels， while reduce the postoperative complications and the recurrence rate.

【Key words】Microsurgery； Spermatic vein ligation； Varicocele； Semen quality

【中圖分類號】R697+.24【文獻標志碼】A

精索靜脈曲張是精索靜脈因多種原因回流受阻、不暢，精索蔓狀靜脈叢擴張、迂曲、伸長，在陰囊里形成蚯蚓形狀的團塊，易引起患者睪丸的功能進行性衰退。主要表現為疼痛、陰囊墜脹不適、精液異常、男性不育等。臨床治療以精索靜脈結扎手術為主，以有效阻止血液的返流[1，2]。近年來，顯微鏡外科精索靜脈結扎術逐漸得到廣泛應用，已成為治療VC的主要術式。本研究旨在探討外環下顯微外科精索靜脈結扎術對精索靜脈曲張患者精液質量的影響，并觀察和分析其安全性。

1資料與方法

1.1一般資料

隨機選擇本院2012年10月至2014年3月精索靜脈曲張患者104例，納入病例：均進行陰囊彩超顯示精索靜脈曲張并伴反流、Valsalva 實驗陽性。排除病例：繼發性精索靜脈曲張患者?！?br>