Clinical study of ligation of spermatic vein under anatomic microscope

doi:10.3877/cma.j.issn.1674-3253.2024.06.010

Abstract

Abstract:

Objective

To compare the clinical effect and complication between anatomical microscopical varicocele ligation and conventional microscopical varicocele ligation for the treatment of varicocele.

Methods

The clinical data of 80 patients with varicocele admitted to Qingdao Municipal Hospital from August 2020 to April 2022 were analyzed. All patients received microscopic varicocele ligation，they were divided into anatomical and conventional group according to different surgical methods.The conventional group underwent surgery in a conventional manner. The anatomical group innovatively dissected the "posterior and lateral spaces of spermatic cord" and used two rubber strips to improve the actual surgical level. The number of ligated vein branches，perioperative complications，operation time，numeric rating scale （NRS），quality of semen after 6 months operation，and recurrence rate were compared between the two groups.

Results

Compared with the conventional group，the operation time in anatomical group was significantly reduced （P＜0.05）. The number of branches of internal spermatic vein ligation in the anatomical group was significantly less than that in the conventional group （P＜0.05）.There were no significant differences in the incidence of perioperative complications，recurrence rate，degree of relief of scrotal pain and the improvement of sperm quality between the two groups （P＞0.05）.

Conclusions

The spermatic vein ligation under the anatomical microscope can effectively improve the patient's sperm quality and clinical symptoms，and can significantly reduce the operation time，the number of operative ligation of spermatic vein and the learning curve，which provides a new idea for microscopic treatment of varicocele in the future.

Key words: Varicocele, Microscope, Anatomical, Minimal invasion

Dengshuang Wu, Monong Li, Xinhong Zhang, Sichuang Hou, Zhilei Qiu. Clinical study of ligation of spermatic vein under anatomic microscope[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 591-596.

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URL: https://zhqjmnmwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3253.2024.06.010

https://zhqjmnmwkzz.cma-cmc.com.cn/EN/Y2024/V18/I06/591

Figures/Tables 4

组别	例数	年龄［岁，（ $\bar{x}$ ±s）］	BMI［kg/m²，（ $\bar{x}$ ±s）］	侧别（例）		精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	NRS评分（ $\bar{x}$ ±s）	就诊原因（例）		超声分度（例）
组别	例数	年龄［岁，（ $\bar{x}$ ±s）］	BMI［kg/m²，（ $\bar{x}$ ±s）］	左侧	双侧	精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	NRS评分（ $\bar{x}$ ±s）	坠胀疼痛	精液质量	Ⅱ度	Ⅲ度
常规组	40	30±8	26±5	37	3	40±16	33±16	4.6±1.5	12	28	20	20
解剖组	40	30±7	27±5	35	5	40±13	35±15	4.7±1.3	15	25	25	15
统计值		t=0.096	t=0.623	χ²=0.139		t=0.172	t=0.662	t=0.464	χ²=0.503		χ²=1.270
P值		0.924	0.535	0.709		0.864	0.510	0.644	0.478		0.260

组别	例数	年龄［岁，（ $\bar{x}$ ±s）］	BMI［kg/m²，（ $\bar{x}$ ±s）］	侧别（例）		精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	NRS评分（ $\bar{x}$ ±s）	就诊原因（例）		超声分度（例）
组别	例数	年龄［岁，（ $\bar{x}$ ±s）］	BMI［kg/m²，（ $\bar{x}$ ±s）］	左侧	双侧	精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	NRS评分（ $\bar{x}$ ±s）	坠胀疼痛	精液质量	Ⅱ度	Ⅲ度
常规组	40	30±8	26±5	37	3	40±16	33±16	4.6±1.5	12	28	20	20
解剖组	40	30±7	27±5	35	5	40±13	35±15	4.7±1.3	15	25	25	15
统计值		t=0.096	t=0.623	χ²=0.139		t=0.172	t=0.662	t=0.464	χ²=0.503		χ²=1.270
P值		0.924	0.535	0.709		0.864	0.510	0.644	0.478		0.260

组别	例数	手术时间［min，（ $\bar{x}$ ±s）］	静脉分支结扎数量［支，（ $\bar{x}$ ±s）］	复发［例（%）］	术后并发症（例）			术后6月精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	术后6月（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	术后6月NRS评分（ $\bar{x}$ ±s）
组别	例数	手术时间［min，（ $\bar{x}$ ±s）］	静脉分支结扎数量［支，（ $\bar{x}$ ±s）］	复发［例（%）］	阴囊水肿	切口感染	附睾炎	术后6月精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	术后6月（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	术后6月NRS评分（ $\bar{x}$ ±s）
常规组	40	51±10	11±4	1（2.50）	0	2	3	60±13	42±18	1.0±0.7
解剖组	40	40±7	8±4	2（5.00）	2	1	1	61±14	50±17	1.1±0.7
统计值		t=5.316	t=3.581	χ²=0.346	χ²=3.347			t=0.363	t=1.766	t=0.328
P值		＜0.001	0.001	0.556	0.341			0.718	0.081	0.744

组别	例数	手术时间［min，（ $\bar{x}$ ±s）］	静脉分支结扎数量［支，（ $\bar{x}$ ±s）］	复发［例（%）］	术后并发症（例）			术后6月精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	术后6月（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	术后6月NRS评分（ $\bar{x}$ ±s）
组别	例数	手术时间［min，（ $\bar{x}$ ±s）］	静脉分支结扎数量［支，（ $\bar{x}$ ±s）］	复发［例（%）］	阴囊水肿	切口感染	附睾炎	术后6月精子密度［×10⁶/ml，（ $\bar{x}$ ±s）］	术后6月（a+b）级精子百分率［%，（ $\bar{x}$ ±s）］	术后6月NRS评分（ $\bar{x}$ ±s）
常规组	40	51±10	11±4	1（2.50）	0	2	3	60±13	42±18	1.0±0.7
解剖组	40	40±7	8±4	2（5.00）	2	1	1	61±14	50±17	1.1±0.7
统计值		t=5.316	t=3.581	χ²=0.346	χ²=3.347			t=0.363	t=1.766	t=0.328
P值		＜0.001	0.001	0.556	0.341			0.718	0.081	0.744

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