摘要
目的比较经导管泡沫硬化剂逆行注射疗法与腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的疗效。方法对101例原发性左侧精索静脉曲张患者行经导管泡沫硬化剂逆行注射治疗(硬化剂组),同期另105例行腹腔镜下精索静脉高位结扎术(高位结扎组)。比较两组患者的住院时间、治疗费用、术后并发症发生率、手术前后精液指标(精子密度、前向运动及正常形态精子比例)以及术后复发率。结果所有患者均顺利完成手术;术后随访12个月,患者症状均明显改善,无深静脉血栓、肺栓塞等严重并发症发生。硬化剂组患者泡沫硬化剂使用量为4~7(5.05±1.05)ml,术中造影精索静脉反流均消失;住院时间(3.55±0.69)d、住院费用(6 634.72±680.24)元、术后鞘膜积液发生率12.9%、阴囊坠胀发生率14.9%分别低于高位结扎组的(5.56±0.89)d、(8640.36±853.88)元、41.0%和25.7%(均P<0.05)。两组患者术后6、12个月精子密度、前向运动比例和正常形态精子比例均较入院时明显改善(均P<0.05),组间比较差异均无统计学意义(均P>0.05);组间精索静脉曲张复发率比较,差异均无统计学意义(均P>0.05)。结论与腹腔镜下精索静脉高位结扎术相比,经导管泡沫硬化剂逆行注射疗法疗效相当,但患者创伤小、恢复快、费用低。
Objective To compare the efficacy and safety between catheter-directed retrograde foam sclerotherapy and laparoscopic varicocelectomy in treatment of patients with varicocele. Methods Patients with primary left varicocle were treated with catheter-directed retrograde sclerotherapy (sclerotherapy group, n=101) or laparoscopic varicocelectomy (varicocelectomy group, n=105). The length of hospital stay, hospital costs, complication rate, semen index, recurrence rate were compared between two groups. Results The treatment completed successfully in both groups. After 12 months of postoperative follow-up, the symptoms of all patients were improved with no recurrence in both groups. The volume of the foam in the sclerotherapy group was 4?7(5.05 ± 1.05)ml, and intraoperative angiography showed that reflux disappeared in all patients. The length of stay [(3.55 土 0.69)d vs (5.56 ±0.89)d], hospital costs [(6634.72 ±680.24)Yuan vs (8640.36 ± 853.88)Yuan], hydrocele rate (12.9% vs 41.0%) and scrotum fall-swell rate (14.9% vs 25.7%) in sclerotherapy group were significantly lower than those in varicocelectomy group (P<0.05). The sperm count, sperm motility and sperm morphology were significantly improved 6, 12 months after the treatment in both groups (P <0.05), there was no significant difference in sperm analysis between two groups (P >0.05). Conclusion Catheter-directed retrograde foam sclerotherapy has the same efficacy as laparoscopic varicocelectomy, with advantages of less injury, fast recovery and low cost in treatment of varicocele patients.
作者
王林君
孟路阳
王彦彬
王松茂
董阳民
诸靖宇
WANG Linjun;MENG Luyang;WANG Yanbin(Department of Vascular Surgery, Hangzhou Third People's Hospital,Hangzhou 310009, China)
出处
《浙江医学》
CAS
2017年第6期452-455,共4页
Zhejiang Medical Journal
