目的: 比较显微外科与腹腔镜途径精索静脉结扎术两种方法治疗精索静脉曲张的疗效与并发症。方法: 采用随机分组的方法,将87例精索静脉曲张患者分成两组:A组有47例患者接受显微外科精索静脉结扎术;B组40例患者接受腹腔镜下精索血管集束结扎术。患者分别于术前和术后6个月进行精液常规检查,记录患者术后住院天数、术后复发及并发症发生情况、精液质量恢复情况等,并进行分析比较。结果: 87例手术均取得成功,分析术后两组平均住院天数差异无统计学意义( P>0.05)。术后随访12个月,结果显示两组术后精索静脉曲张复发率差异无统计学意义( P>0.05),术后两组并发症发生率有统计学意义( P<0.05),主要为B组发生睾丸萎缩(1例,2.5%)和阴囊水肿(3例,7.5%)。两组患者术后6个月复查精液常规,精液质量均较术前有所改善,两组间精液的精子密度、畸形率、A+B级精子率比较差异有统计学意义( P<0.05)。结论: 显微外科与腹腔镜治疗精索静脉曲张在提高精液质量上均有效,显微外科对VC患者具有创伤小、并发症少和恢复快等优点,是治疗精索静脉曲张的有效方法。

Objective: To compare the effects and postoperative complications of microscopic varicocelectomy (MV) and laparoscopic varicocelectomy (LV) in the treatment of varicocele (VC).Methods: We assigned 87 VC patients to two groups randomly: group A ( n=47), receiving MV, and the rest ( n=41) given LV as group B. The semen parameters before and 6 months after surgery, as well as the post-operative hospital stay, the post-operative recurrence, the post-operative complications, and the recovery of the semen quality were compared between two groups.Results: Surgeries for all the patients were successful, and no significant difference in the post-operative hospital stay between the two groups ( P>0.05). During a follow-up period of 12 months, the recurrence rate showed no significant difference between two groups ( P>0.05). However, the complications rate was significantly lower in group A than in group B (One case of orchiatrophy and two cases of hydrocele in group B). In addition, after 6 months of follow-up, the quality of semen was significantly increased in the both groups, however, the sperm concentration, aberration rate and A+B grade sperm rate were significantly different between the two groups ( P<0.05).Conclusions: MV and LV are valid for improving the quality of semen for VC patients, while MV is superior to LV for its minimal invasiveness, lower incidence of postoperative complications and it can make the patients recover more quickly, which is regarded as an effective method for the treatment of VC.