精索内静脉栓塞术与腹腔镜精索内静脉高位结扎术疗效对比【摘要】目的研究分析精索?染猜鏊ㄈ?术与腹腔镜精索内静脉高位结扎术治疗原发性精索静脉曲张的临床效果对比。方法60例原发性精索静脉曲张患者，根据治疗方法不同分成精索内高位结扎组和精索内静脉栓塞组，各30例。精索内高位结扎组应用精索内高位结扎术治疗，精索内静脉栓塞组应用精索内静脉栓塞治疗。分析比较两组患者手术时间、住院时间、不良反应发生情况及1年精索静脉曲张的复发率。结果精索内高位结扎组手术时间（38.2±15.8）d短于精索内静脉栓塞组的（78.5±20.4）d，精索内高位结扎组的住院时间（3.5±0.7）d长于精索内静脉栓塞组的（1.5±0.5）d，精索内高位结扎组复发率3.7%低于精索内静脉栓塞组的30.0%，精索内高位结扎组并发症发生率16.7%高于精索内静脉栓塞组的0，差异均有统计学意义（P<0.05）。结论治疗精索静脉曲张，精索内高位结扎组时间短，并发症少；介入性栓塞手术无瘢痕，恢复最快，复发率低。可依据原发性精索静脉曲张患者的具体情况使用选择相应手术方法。【关键词】原发性精索静脉曲张；精索内静脉栓塞术；腹腔镜精索内静脉高位结扎术DOI：10.14163/jki.11-5547/r.2017.04.016【Abstract】ObjectiveTostudytheclinicaleffectofvenousthrombosiswithinspermaticcordandlaparoscopichighligationoperationofinternalspermaticveininthetreatmentofprimaryvaricocele.MethodsAtotalof60primaryvaricocelepatientsweredividedbydifferenttreatmentmeasuresintohighligationwithinspermaticcordgroupandvenousthrombosiswithinspermaticcordgroup，with30casesineachgroup.Thehighligationwithinspermaticcordgroupreceivedhighligationwithinspermaticcordtreatment，andthevenousthrombosiswithinspermaticcordgroupreceivedvenousthrombosiswithinspermaticcordtreatment.Analysisandcomparsionweremadeonoperationtime，hospitalstaytime，occurrenceofadversereactions，recurrenceofvaricocelein1yearbetweentwogroups.ResultsThehighligationwithinspermaticcordgrouphadshorteroperationtimeas（38.2±15.8）dthan（78.5±20.4）dinthevenousthrombosiswithinspermaticcordgroup.Thehighligationwithinspermaticcordgrouphadlongerhospitalstaytimeas（3.5±0.7）dthan（1.5±0.5）dinthevenousthrombosiswithinspermaticcordgroup.Thehighligationwithinspermaticcordgrouphadlowerrecurrencerateas3.7%than30.0%inthevenousthrombosiswithinspermaticcordgroup.Thehighligationwithinspermaticcordgrouphadhigherincidenceofcomplicationsas16.7%than0inthevenousthrombosiswithinspermaticcordgroup.Alltheirdifferenceshadstatisticalsignificance（P<0.05）.ConclusionForthetreatmentofvaricocele，highligationwithinspermaticcordprovidesshorttimeandlesscomplications，whileinterventionalthrombosisoperationhasnoscar，fastestrecoveryandlowrecurrencerate.Appropriatesurgicalmethodshouldbechosenaccordingtothespecificconditionofvaricocelepatients.【Keywords】Primaryvaricocele；Venousthrombosiswithinspermaticcord；Laparoscopichighligationoperationofinternalspermaticvein当代21世纪中，男性的不育症俨然成为一个严重的社会伦理问题，其发病率在全世界范围内逐年升高。精索静脉曲张（varicocele，VC）是一种血管性病变，指精索内蔓状静脉丛的异常扩张、伸长和迂曲，可导致疼痛不适及进行性睾丸功能减退，是男性不育的常见原因之一[1-3]。因其相关的阴囊疼痛不适、不育与睾丸萎缩等而广受关注。在男性泌尿生殖系统疾病属于常见多发疾病。多见于青壮年，发病率占正常男性人群的10%～15%，在男性不育症中占19%～41%。精索静脉曲张是由于包绕精索的精索静脉和蔓状静脉丛的扩张而引起的血管性精子发生障碍。通常见于左侧，约占77%～92%，亦可双侧发病，约占7%～22%，少见单发于右侧，约占1%。传统手术采用腹股沟切口，作结扎精索内静脉，并切除阴囊内部分扩张静脉[4，5]...