Hsieh Ming-Li, Chang Phei-Lang, Huang Shih-Tsung, Wang Ta-Ming, Tsui Ke-Hung
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.
Chang Gung Med J. 2003 Jul;26(7):479-84.
Microsurgical sub-inguinal varicocelectomy has been associated with extremely high success rates and minimal postoperative complications. The aim of this study was to report the techniques and outcomes of varicocelectomy using a modified microsurgical method, specifically a loupe-assisted high inguinal varicocelectomy instead of the usual microscope and sub-inguinal approach.
From 1997 through 2000, 116 patients underwent modified high inguinal varicocelectomy. All patients had at least a 1-year history of infertility with abnormal semen parameters and varicocele proven by physical examination and/or color Doppler ultrasound. Varicocelectomy was performed as an outpatient procedure. To facilitate the procedure, a x3.0 loupe was used during the spermatic cord dissection at the level of the internal inguinal ring. During dissection, the dilated veins were ligated and divided including vasal veins and external spermatic veins. All of the patients were followed postoperatively with semen analysis and physical examination every 3 months.
A total of 96 patients were followed for more than 1 year, with at least two semen analyses being conducted. Moreover, 136 varicocelectomies were performed among the 96 patients. No intra-operative complications occurred. A temporary reactive hydrocele was noted in one patient, but subsequently completely resolved. In addition, recurrent or persistent varicocele was identified by physical examination and/or color Doppler in four patients (2.9%). Motile sperm concentration increased from 31.8 +/- 18.6% to 47.5 +/- 16.9% (p = 0.0004) in the sample group, and the sperm concentration (10(6)/cc) increased from 26.2 +/- 18.7 to 42.8 +/- 28.5 (p = 0.0002).
Loupe-assisted high inguinal varicocelectomy is a safe, simple. and effective method for the treatment of sub-fertile men, especially in medical facilities without microscopic equipment. However, further study with control groups is needed to strengthen the evidence.
显微外科腹股沟下精索静脉结扎术成功率极高且术后并发症极少。本研究旨在报告采用改良显微外科方法进行精索静脉结扎术的技术及结果，具体为使用放大镜辅助的高位腹股沟精索静脉结扎术，而非常用的显微镜及腹股沟下手术入路。
1997年至2000年期间，116例患者接受了改良高位腹股沟精索静脉结扎术。所有患者均有至少1年的不育病史，精液参数异常，且经体格检查和/或彩色多普勒超声证实患有精索静脉曲张。精索静脉结扎术作为门诊手术进行。为便于手术操作，在腹股沟内环水平进行精索解剖时使用了3.0倍放大镜。解剖过程中，结扎并切断扩张的静脉，包括输精管静脉和精索外静脉。所有患者术后每3个月进行精液分析和体格检查随访。
共有96例患者接受了超过1年的随访，至少进行了两次精液分析。此外，这96例患者共进行了136次精索静脉结扎术。术中无并发症发生。1例患者出现暂时性反应性鞘膜积液，但随后完全消退。另外，通过体格检查和/或彩色多普勒发现4例患者（2.9%）存在复发性或持续性精索静脉曲张。样本组中，活动精子浓度从31.8±18.6%增至47.5±16.9%（p = 0.0004），精子浓度（10⁶/cc）从26.2±18.7增至42.8±28.5（p = 0.0002）。
放大镜辅助的高位腹股沟精索静脉结扎术是治疗不育男性的一种安全、简单且有效的方法，尤其适用于没有显微设备的医疗机构。然而，需要进行有对照组的进一步研究以强化证据。
