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目的比较显微镜外环下精索静脉结扎术(MSV)与腹膜后精索内静脉高位结扎术(HRV)治疗重度精索静脉曲张(VC)的临床疗效及安全性。方法收治的双侧重度VC患者随机分为显微镜外环下精索静脉结扎术组(MSV组)与腹膜后精索内静脉高位结扎术组(HRV组)64例。比较两组年龄(PA)、精索静脉宽度(VCW)、手术时间(OT)、术中出血(BL)、术后住院时间(HST)、精索静脉曲张复发率(VRR)、睾丸鞘膜积液发生率(HI)、睾丸萎缩率(TAR)、自然怀孕率(PR)、精子密度(SC)、精子活力(SM)、精子畸形率(SDR)、精子质量改善率(SQIR)、阴囊VAS疼痛评分、阴囊疼痛缓解率(SPRR)、IIEF-5评分及血清促卵泡素(FSH)、促黄体生成素(LH)、睾酮(T)、游离睾酮(FT)等情况。结果两组间PA、VCW、BL、SPRR、HI及TAR无明显差异(P>0.05)。MSV组OT大于HRV组(P<0.01),MSV组术后PR、SQIR大于HRV组(P<0.05),MSV组术后VRR小于HRV组(P<0.05),MSV组术后HST小于HRV组(P<0.01)。两组间患者术前术后LH、FSH、T、FT、阴囊VAS疼痛评分、IIEF-5评分及术前SC、SM、SDR无显著性差异(P>0.05),两组术后SC、SM及SDR均较术前有明显改善(P<0.01),MSV组术后SC、SM大于HRV组(P<0.01),MSV组的术后SDR低于HRV组(P<0.01)。结论 MSV治疗重度VC可更有效改善精子质量,增加怀孕率,具有满意疗效,同时具备恢复快、并发症少等优点。
Objective To compare the clinical efficacy and safety of microscopic external varicocele ligation (MSV) and retroperitoneal spermatic vein hyperplasia (HRV) in the treatment of severe varicocele (VC). Methods Bilateral severe VC patients were randomly divided into two groups: 64 cases in MSV group and HRV group (retroperitoneal spermatic vein ligation group). PA, CVW, BL, postoperative hospital stay (HST), varicocele recurrence (VRR), testicular sheath (HI), testicular atrophy (TAR), spontaneous pregnancy rate (PR), sperm density (SC), sperm motility (SM), sperm abnormality (SDR), sperm quality improvement (SQIR) VAS pain score, scrotal pain relief rate (SPRR), IIEF-5 score and serum FSH, LH, T and FT. Results There was no significant difference in PA, VCW, BL, SPRR, HI and TAR between the two groups (P> 0.05). (P <0.05). The postoperative VRR of MSV group was lower than that of HRV group (P <0.05). The postoperative HST of MSV group was lower than that of HRV group (P <0.01). There were no significant differences in the scores of LH, FSH, T, FT, scrotal VAS pain score, IIEF-5 score and preoperative SC, SM and SDR between the two groups (P> 0.05) (P <0.01). The postoperative SC and SM in MSV group were higher than HRV group (P <0.01). The postoperative SDR in MSV group was lower than that in HRV group (P <0.01). Conclusion MSV treatment of severe VC can be more effective in improving sperm quality, increase the pregnancy rate, with satisfactory curative effect, at the same time with rapid recovery, fewer complications and so on.