摘要
目的探讨3种不同手术方式治疗沿海驻防部队官兵精索静脉曲张(VC)的临床疗效及对精液质量的影响。方法回顾性分析2016年1月至2023年12月在联勤保障部队北戴河康复疗养中心手术治疗的107例VC患者的临床资料。依据VC手术方式分为3组:A组采用腹膜后VC高位结扎术(改良Palomo术式,n=37),B组采用腹腔镜VC高位结扎术(n=34),C组采用显微镜下VC结扎术(n=36)。统计3组患者手术时间、住院时间及手术出血量,采用伟力计算机辅助精子质量分析仪检测各组患者术前及术后6个月的精子密度、精子畸形率、精子活力(a+b级)。患者于术后1、3、6个月后复诊,统计3种不同手术方式患者并发症发生情况;另外,观察3种不同手术方式患者术后6个月VC复发情况。结果3组患者术中出血量比较差异无统计学意义(P>0.05);C组患者手术时间明显长于A、B组,住院时间明显短于A、B组(均P<0.01)。与术前比较,3组患者治疗后精子活力(a+b级)、精子密度均明显升高,精子畸形率明显降低(均P<0.01);C组患者治疗后精子活力(a+b级)、精子密度均明显高于A、B组,精子畸形率明显低于A、B组(均P<0.05)。术后C组患者并发症发生率(5.6%,2/36)明显低于A组(24.3%,9/37)、B组(20.6%,7/34)(均P<0.05)。术后6个月随访,C组患者复发率(2.8%,1/36)明显低于A组(13.5%,5/37)、B组(17.6%,6/34)(均P<0.05)。结论显微镜下VC结扎术较其他2种术式的创伤小、术后并发症发生率和复发率低,能明显改善VC患者的精液质量,可作为临床治疗VC的首选术式。
Objective:To investigate the clinical efficacy of three different surgical approaches in coastal garrison military personnel with varicocele(VC)and their impacts on semen quality.Methods:A retrospective analysis was conducted on the clinical data of 107 VC patients who underwent surgical treatment at the Department of Urology of Beidaihe Rehabilitation and Recuperation Center of PLA Joint Logistics Support Force from January 2016 to December 2023.The patients were divided into three groups based on VC surgical approaches:Group A underwent retroperitoneal high ligation of VC(modified Palomo procedure,n=37);Group B underwent laparoscopic high ligation of VC(n=34);Group C underwent microscopic ligation of VC(n=36).The operative time,hospital stay,and intraoperative blood loss were recorded for all three groups.The sperm density,sperm morphology abnormal rate,and sperm motility(Grade a+b)were assessed before operation and 6 months postoperatively using the Weili computer-assisted semen analyzer.The patients were followed up at 1,3,and 6 months postoperatively to record the incidence of complications.Additionally,recurrence rates of VC were observed 6 months after surgery across the three groups.Results:There was no significant difference in intraoperative blood loss among the three groups(P>0.05).Group C exhibited longer operative time but shorter hospital stay compared with Groups A and B(all P<0.01).Postoperatively,all groups showed significant improvements in sperm motility(grade a+b),sperm density,and reduction in sperm deformity rates(P<0.01).Group C showed significantly higher sperm motility(grade a+b)and density,as well as lower deformity rates,than Groups A and B(all P<0.05).The postoperative complication rates in Group C(5.6%,2/36)were significantly lower than those in Group A(24.3%,9/37)and Group B(20.6%,7/34)(all P<0.05).At 6-month follow-up,recurrence rates in Group C(2.8%,1/36)were significantly lower than those in Group A(13.5%,5/37)and Group B(17.6%,6/34)(all P<0.05).Conclusion:Microscopic ligation of VC offers minimally invasive advantages,lower complication and recurrence rates,and significantly improves semen quality in VC patients,making it the preferred clinical treatment for VC.
作者
王卫红
王玉富
姜梅
魏金凤
何辉
李晓萌
孙建新
党笑坤
王哲
刘武岩
Wang Weihong;Wang Yufu;Jiang Mei;Wei Jinfeng;He Hui;Li Xiaomeng;Sun Jianxin;Dang Xiaokun;Wang Zhe;Liu Wuyan(Beidaihe Rehabilitation and Recuperation Center of PLA Joint Logistics Support Force,Qinhuangdao 066100,China;No.983 Hospital of The PLA Joint Logistics Support Force,Tianjin 300143,China)
出处
《中华航海医学与高气压医学杂志》
2025年第7期673-677,共5页
Chinese Journal of Nautical Medicine and Hyperbaric Medicine
基金
河北省医学科学计划资助项目(2024-07)。
