切换至 "中华医学电子期刊资源库"
高级检索
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
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

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]. 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]. 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
[1]
邓春华, 商学军.精索静脉曲张诊断与治疗中国专家共识[J]. 中华男科学杂志, 2015, 21(11): 1035-1042.
[2]
Mesrur SS, Lisette H, Josine Q, et al. Treatment of varicocele in children and adolescents: a systematic review and meta-analysis from european association of urology/european society for paediatric urology guidelines panel[J]. Eur Urol, 2019, 75(3): 448-461.
[3]
Zavattaro M, Ceruti C, Motta G，et al. Treating varicocele in 2018: current knowledge and treatment options[J]. J Endocrinol Invest, 2018, 41(12): 1365-1375.
[4]
李宏军. 男性不育伴精索静脉曲张的治疗策略[J]. 中华男科学杂志, 2018, 24(3): 195-198.
[5]
王晓利, 王璟琦, 王东文. 腹腔镜手术治疗精索静脉曲张的进展[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(2): 139-141.
[6]
张立元, 张小康, 剡锐, 等. 经腹腔入路腹腔镜高选择性精索静脉结扎术的疗效观察 [J/OL]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(6): 452-455.
[7]
苗腾飞, 王利辉, 李云龙,等.精准分离精索内静脉的腹腔镜精索静脉高位结扎术对精索静脉曲张的临床疗效分析[J]. 临床泌尿外科杂志, 2022, 37(6): 422-426+435.
[8]
Demirdöğen ŞO, Özkaya F, Cinislioğlu AE,et al. A comparison between the efficacy and safety of microscopic inguinal and subinguinal varicocelectomy[J]. Turk J Urol, 2019, 45(4): 254-260.
[9]
Majzoub A, ElBardisi H, Covarrubias S, et al. Effect of microsurgical varicocelectomy on fertility outcome and treatment plans of patients with severe oligozoospermia: An original report and meta-analysis[J]. Andrologia, 2021, 53(6): e14059-e14059.
[10]
Wang H, Ji ZG. Microsurgery versus laparoscopic surgery for varicocele: a meta-analysis and systematic review of randomized controlled trials[J]. J Invest Surg, 2020, 33(1): 40-48.
[11]
唐启胜, 王磊, 李瑞晓, 等. 腹腔镜下高选择性精索静脉高位结扎与显微镜下低位精索静脉结扎术的疗效对比[J]. 中华男科学杂志, 2018, 24(9): 782-787.
[12]
Wu X, Liu Q, Zhang R, et al. Therapeutic efficacy and safety of laparoscopic surgery versus microsurgery for varicocele of adult males: A meta-analysis[J]. Medicine (Baltimore), 2017, 96(34): e7818.
[13]
吴杰英,李腾成,黄展森,等.腹腔镜精索静脉高位结扎术中保留睾丸动脉的手术技巧和临床疗效[J].中华泌尿外科杂志, 2021, 42(4): 294-299.
[14]
Almekaty K, Zahran MH, Zoeir A, et al. The role of artery-preserving varicocelectomy in subfertile men with severe oligozoospermia: a randomized controlled study[J]. Andrology, 2019, 7(2): 193-198.
[15]
杨彬, 王浦, 李宏军,等. 腹腔镜下精索内脉管系统的解剖结构特点研究[J]. 中华男科学杂志, 2016, 22(5): 406-410.
[16]
张金可, 邵为民, 陈涤平, 等. 显微镜下精索静脉结扎术治疗精索静脉曲张的应用解剖[J].现代泌尿外科杂志, 2018, 23(9): 672-676.
[1] 李凯, 陈淋, 向涵, 苏怀东, 张伟. 一种U型记忆合金线在经脐单孔腹腔镜阑尾切除术中的临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 15-15.
[2] 杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.
[3] 周岩冰, 刘晓东. 腹腔镜右半结肠癌D3根治术消化道吻合重建方式的选择[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 9-13.
[4] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[5] 王春荣, 陈姜, 喻晨. 循Glisson蒂鞘外解剖、Laennec膜入路腹腔镜解剖性左半肝切除术临床应用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 37-40.
[6] 李晓玉, 江庆, 汤海琴, 罗静枝. 围手术期综合管理对胆总管结石并急性胆管炎患者ERCP +LC术后心肌损伤的影响研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 57-60.
[7] 甄子铂, 刘金虎. 基于列线图模型探究静脉全身麻醉腹腔镜胆囊切除术患者术后肠道功能紊乱的影响因素[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 61-65.
[8] 逄世江, 黄艳艳, 朱冠烈. 改良π形吻合在腹腔镜全胃切除消化道重建中的安全性和有效性研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 66-69.
[9] 曹迪, 张玉茹. 经腹腔镜生物补片修补直肠癌根治术后盆底疝1例[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 115-116.
[10] 李三祥, 李佳, 刘俊峰, 吕东晨, 方晖东, 谭朝晖, 刘杰, 潘佐, 乔建坤. 基于CT影像的三维重建成像技术在腹腔镜大肾上腺肿瘤切除术中的应用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 570-574.
[11] 赵佳晖, 王永兴, 彭涛, 李明川, 魏德超, 韩毅力, 侯铸, 姜永光, 罗勇. 后腹腔镜根治性肾切除手术时间延长和术中出血量增多的影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(06): 575-580.
[12] 叶晋生, 路夷平, 梁燕凯, 于淼, 冀祯, 贺志坚, 张洪海, 王洁. 腹腔镜下应用生物补片修补直肠术后盆底缺损的疗效[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 688-691.
[13] 夏松, 姚嗣会, 汪勇刚. 经腹腹膜前与疝环充填式疝修补术治疗腹股沟疝的对照研究[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 702-705.
[14] 林文斌, 郑泽源, 郑文能, 郁毅刚. 外伤性脾破裂腹腔镜脾切除术患者中转开腹风险预测模型构建[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 619-623.
[15] 牛朝, 李波, 张万福, 靳文帝, 王春晓, 李晓刚. 腹腔镜袖状胃切除联合胆囊切除治疗肥胖合并胆囊结石安全性和疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 635-639.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号