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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (03) : 261 -264. doi: 10.3877/cma.j.issn.1674-3253.2023.03.013

临床研究

保留睾丸动脉的腹腔镜精索内静脉高位结扎术对精索静脉曲张致不育的疗效分析
王晓利1, 李琦1, 李春风2, 王璟琦3,†(), 管晓东1   
  1. 1. 044000　运城，山西医科大学附属运城医院泌尿外科
    2. 030001　太原，山西医科大学第一医院泌尿外科
    3. 山西医科大学第二医院泌尿外科
  • 收稿日期:2023-01-09 出版日期:2023-06-01
  • 通信作者: 王璟琦

Effect of laparoscopic high ligation of internal spermatic vein with testicular artery preservation on infertility caused by varicocele

Xiaoli Wang1, Qi Li1, Chunfeng Li2, Jingqi Wang3,†(), Xiaodong Guan1   

  1. 1. Department of Urology, Yuncheng Hospital Affiliated to Shanxi Medical University, Yuncheng 044000, China
    2. Department of Urology, the First Hospital of Shanxi Medical University
    3. Department of Urology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2023-01-09 Published:2023-06-01
  • Corresponding author: Jingqi Wang
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王晓利, 李琦, 李春风, 王璟琦, 管晓东. 保留睾丸动脉的腹腔镜精索内静脉高位结扎术对精索静脉曲张致不育的疗效分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 261-264.

Xiaoli Wang, Qi Li, Chunfeng Li, Jingqi Wang, Xiaodong Guan. Effect of laparoscopic high ligation of internal spermatic vein with testicular artery preservation on infertility caused by varicocele[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 261-264.

目的

探究腹腔镜下精索内静脉高位结扎术中通过保留睾丸动脉对治疗精索静脉曲张导致不育的临床疗效。

方法

回顾性分析2014年1月至2016年12月山西医科大学第一医院行腹腔镜手术治疗的精索静脉曲张伴不育患者，共完整收集病例资料69例，按照腹腔镜精索静脉高位结扎术中对睾丸动脉处理方式的不同，将其分为两组。A组：保留睾丸动脉36例；B组：精索血管集束结扎33例。统计比较两组患者精子质量改善情况，自然生育率，并发症和复发率。

结果

精子质量改善情况：（1）两组术后较术前均有明显改善（P<0.05）；（2）两组比较，A组精子密度和精子活力改善率均高于B组（P<0.05）；自然生育率比较：A组生育率高于B组（P<0.05）。并发症发生情况：（1）两组各有3例睾丸鞘膜积液，差异无统计学意义（P>0.05）；（2）A组无睾丸萎缩，B组有1例睾丸萎缩，A、B组比较差异无统计学意义（P>0.05）。复发率比较：A组有1例复发，B组有2例复发，两组比较差异无统计学意义（P>0.05）。

结论

对于精索静脉曲张不育患者，两种手术方式都可以明显地改善精子密度和活力，但保留睾丸动脉组的精子质量改善情况和自然生育率显著优于集束结扎组，而在并发症（睾丸鞘膜积液、萎缩）和复发率方面，两组无显著差别。

关键词: 精索静脉曲张, 不育, 腹腔镜, 精索静脉结扎术, 睾丸动脉, 集束结扎, 精准治疗
Objective

To explore the clinical efficacy of laparoscopic high ligation of internal spermatic vein in the treatment of infertility caused by varicocele by preserving testicular artery.

Methods

69 cases of infertile patients with varicocele from January 2014 to December 2016 of the First Hospital of Shanxi Medical University were analyzed retrospectively. According to the surgical method, the patients were divided into two groups. Group A: 36 cases were reserved for the testicular artery, group B: 33 cases were ligated by the cluster of spermatic vessels.The sperm quality improvement, natural fertility rate, postoperative complication rate and recurrence rate were compared between the two groups, and the clinical effects of the two surgical methods were analyzed and evaluated.

Results

Semen parameters improvement: (1)there was significant improvement in two groups after operation compared with those before operation (P<0.05); (2)the improvement rate of sperm density and motility in group A was higher than those in group B (P<0.05). Natural fertility: the fertility rate of group A was higher than that of group B (P<0.05). Complications: (1) there were 3 cases of hydrocele in the testis in both groups and the difference between the two groups was not statistically significant (P>0.05); (2) there was no testicular atrophy in group A, and there was 1 case of testicular atrophy in group B, the difference between the two groups was not statistically significant (P>0.05). Recurtence rate: there was 1 case of relapse in group A and 2 cases in group B and the difference between the two groups was not statistically significant (P>0.05).

Conclusions

The sperm quality recovery and natural fertility of the reserved testicular artery group are superior to those of the spermatic vessel cluster ligation group. There was no significant difference in the hydrocele of the testicle, atrophy of the testis and the recurrence of varicocele between the two methods.

Key words: Varicocele, Infertility, Laparoscopy, Varicocelectomy, Testicular artery, Cluster ligation, Precision theraphy
表1 两组精索静脉曲张伴不育患者一般资料比较
组别 例数 年龄[岁，(±s)] 分度(例) 部位(例)
Ⅰ度 Ⅱ度 Ⅲ度 单侧 双侧
保留睾丸动脉组(A) 36 28±3 8 14 14 23 13
精索血管集束结扎组(B) 33 27±3 8 13 12 23 10
统计值   t=-1.798 χ2=0.061 χ2=0.261
P值   0.077 0.970 0.609
表2 精索静脉曲张伴不育患者手术前后精子密度、活力对比（±s）
时间 A组精子密度（×106/ml） A组精子活力（a+b%） B组精子密度（×106/ml） B组精子活力（a+b%）
术前 24±8 23±8 23±6 23±8
术后 36±11 43±15 29±7 32±13
t值 t=-6.426 t=-8.207 t=-6.371 t=-5.250
P值 <0.001 <0.001 <0.001 <0.001
表3 两组精索静脉曲张伴不育患者术后精子质量改善情况对比[例(%)]
组别 例数 精子密度改善 精子活力改善
保留睾丸动脉组(A) 36 25（69.44） 30（83.33）
精索血管集束结扎组(B) 33 15（45.45） 20（60.61）
χ2值   4.067 4.457
P值   0.044 0.035
表4 两组精索静脉曲张伴不育患者术后自然生育情况、并发症对比[例(%)]
组别 例数 自然生育 睾丸鞘膜积液 睾丸萎缩 复发
A 36 17（47.22） 3（8.33） 0（0） 1（2.78）
B 33 8（24.24） 3（9.09） 1（3.03） 2（6.06）
统计值   χ2=3.935 χ2=0.000 - χ2=0.006
P值   0.047 1.000 0.478 0.939
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