Varicocelectomy for male infertility: A comparative study of open, laparoscopic and microsurgical approaches
Varicocelectomy for male infertility: A comparative study of open, laparoscopic and microsurgical approaches
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DOI：
10.1016/j.juro.2008.03.050
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发表时间：
2008-07-01
影响因子：
6.6
通讯作者：
Shokeir, Ahmed A.
中科院分区：
文献类型：
--
作者：
Al-Said, Sami;Al-Naimi, Abdulla;Shokeir, Ahmed A.
目的：我们比较了3种技术的精索静脉曲张切除术在不育患者的精索静脉曲张。材料和方法：这项研究包括298名不育患者（446精索静脉曲张）谁被随机精索静脉曲张切除术开放腹股沟技术在92，腹腔镜在94和腹股沟下显微手术在112。比较3种技术的术中、术后早期和晚期参数、精液参数变化和妊娠率。患者随访+/-平均+/- SD为21 +/- 9个月（范围4至35）。结果：显微镜组的手术时间明显较长。3组的早期术后并发症相当。在随访时，显微手术组中没有患者出现鞘膜积液，而开放组中有4/143例（2.8%）患者出现鞘膜积液，腹腔镜组中有8/148例（5.4%）患者出现鞘膜积液，这代表了有利于显微手术的显著差异。显微手术组的精索静脉曲张复发率显著低于开放手术组和腹腔镜组（分别为4/155或2.6% vs 16/143或11%和25/148或17%）。与术前相比，3组术后精液参数显示精子浓度、活动力和形态学均显著改善。显微手术组精子计数和活力改善的患者发生率明显较高。结论：显微手术治疗精索静脉曲张与开腹手术和腹腔镜手术相比，无鞘膜积液形成，复发率低，精子数和活动率提高。
Purpose: We compared the outcomes of 3 techniques of varicocelectomy in infertile patients with varicocele.Materials and Methods: The study included 298 infertile patients (446 varicoceles) who were randomized to varicocelectomy by an open inguinal technique in 92, laparoscopy in 94 and subinguinal microsurgery in 112. The 3 techniques were compared regarding intraoperative, and early and late postoperative parameters, changes in semen parameters and the pregnancy rate. Patients were followed a +/- mean +/- SD of 21 +/- 9 months (range 4 to 35).Results: Operative time was significantly longer in the microscopic group. Early postoperative complications were comparable in the 3 groups. At followup none of the patients in the microsurgical group had hydrocele, while it was observed in 4 of 143 (2.8%) in the open group and in 8 of 148 (5.4%) in the laparoscopy group, representing a significance difference in favor of microsurgery. The incidence of recurrent varicocele was significantly lower in the microsurgical group than in the open and laparoscopy groups (4 of 155 patients or 2.6% vs 16 of 143 or 11% and 25 of 148 or 17%, respectively). Compared to preoperative values in the 3 groups postoperative semen parameters showed significant improvement in sperm concentration, motility and morphology. The incidence of patients with improved sperm count and motility was significantly higher in the microsurgical group. The pregnancy rate at 1 year was not significantly different among the 3 groups.Conclusions: Compared with open and laparoscopic varicocele treatment microsurgical varicocelectomy has the advantages of no hydrocele formation, a lower incidence of recurrent varicocele, and better improvement in sperm count and motility.