徐淳 王海峰

[摘要] 目的 比较显微镜与腹腔镜精索静脉结扎术治疗精索静脉曲张的效果。 方法 选取2014年1月～2015年2月在本科就诊的80例精索静脉曲张患者作为研究对象，随机分为腹腔镜组和显微镜组，各40例。比较手术前后的精液质量、手术时间、住院时间、胃肠功能恢复时间、配偶妊娠率、术后并发症发生率及复发率。 结果 两组术后的精子存活率、精子浓度和（a+b）级精子百分率显著高于术前，差异有统计学意义（P<0.05）。显微镜组的手术时间显著长于腹腔镜组，胃肠功能恢复时间显著短于腹腔镜组，差异有统计学意义（P<0.05）。显微镜组的阴囊水肿发生率、术后复发率显著低于腹腔镜组，配偶妊娠率显著高于腹腔镜组，差异有统计学意义（P<0.05）。 结论 显微镜精索静脉结扎术治疗精索静脉曲张效果显著，创伤小、术后并发症少、复发率低、恢复快，值得临床推广应用。

[关键词] 精索静脉曲张；显微镜；腹腔镜；精索静脉结扎术

[中图分类号] R691.9 [文献标识码] A [文章编号] 1674-4721（2016）03（a）-0071-04

[Abstract] Objective To explore the effect of spermatic vein ligation under microscope and laparoscope in the treatment of varicocele. Methods 80 patients with varicocele from January 2014 to February 2015 in our department were selected and randomly divided into the microscope group and the laparoscope group，40 cases in each group.The sperm quality，operation time，hospital stay，gastrointestinal function recovery time，rate of pregnancy in spouse，the incidence rate of postoperative complication and recurrence rate before and after surgery in the two groups was compared respectively. Results The survival rate of sperm，sperm concentration，percentage of sperm of grade （a+b） after surgery in the two groups was higher than that before surgery，with significant difference （P<0.05）.Operation time in the microscope group was longer than that in the laparoscope group，the time of gastrointestinal function recovery in the microscope group was shorter than that in the laparoscope group，with significant difference （P<0.05）.The incidence rate of edema of scrotum and recurrence rate in the microscope group was lower than that in the laparoscope group，the rate of pregnancy of spouse in the microscope group was higher than that in the laparoscope group，with significant difference （P<0.05）. Conclusion The effect of spermatic vein ligation under microscope in the treatment of varicocele is remarkable，the wound is small，the complication after operation is little，the recurrence rate is low，the recovery is quick，it is worthy of clinical promotion and application.

[Key words] Varicocele；Microscope；Laparoscope；Spermatic vein ligation

精索静脉曲张是指精索静脉瓣膜功能受损或回流受阻导致蔓状静脉丛迂曲、扩张和伸长，进而导致睾丸生精功能障碍的一种疾病。本病多见于青壮年，青春期后发病率为15%～16%[1]。WHO公布的资料显示，导致男性不育的首要病因即为精索静脉曲张。相关文献[2-4]报道，原发性不育患者发生率约为35%，继发性不育患者发生率高达75%～81%。手术仍是治疗本病的主要方法，目前，国内治疗精索静脉曲张的术式主要为传统开放手术、腹腔镜精索静脉高位结扎术、显微镜精索静脉结扎术和精索静脉栓塞术。腹腔镜和显微镜术式由于术后并发症少、复发率低、创伤小、恢复快、技术成熟等优势在基层医院逐渐被开展[5-8]。本研究选取在本科就診的精索静脉曲张患者作为研究对象，给予腹腔镜经腹径路与显微镜经腹股沟径路精索静脉结扎术治疗，旨在探讨两种术式的临床效果。……