Shiraishi Koji, Oka Shintaro, Ito Hideaki, Matsuyama Hideyasu
Department of Urology, Yamaguchi University School of Medicine, Yamaguchi, Japan.
J Androl. 2012 Nov-Dec;33(6):1387-93. doi: 10.2164/jandrol.112.016444. Epub 2012 Jun 14.
The simplicity of the surgical procedure, as well as the high rate of success and low rate of complications, is of particular importance for varicocelectomies. We compared operative parameters, complication rates, and sperm parameters after retroperitoneal, microsurgical subinguinal and high inguinal varicocelectomy approaches in infertile men with varicoceles. This study included 307 infertile men with left varicoceles who underwent varicocelectomy by the retroperitoneal (n = 43), microsurgical subinguinal (n = 107), or high inguinal (n = 157) approach. The operative time was shorter for the retroperitoneal approach (29 minutes) compared with the microsurgical approaches and was significantly shorter for the high inguinal approach (52 minutes) compared with the subinguinal approach (66 minutes). Pain, as assessed by a visual analogue scale, and the use of nonsteroidal anti-inflammatory drugs were greatest following the retroperitoneal approach and significantly preferable following the high inguinal compared with the subinguinal approach. Recurrence/hydrocele was observed in 9.3%/9.3%, 0.9%/0.9%, and 1.3%/0.6% of patients after use of the retroperitoneal, subinguinal, and high inguinal approaches, respectively. Significant postoperative improvements in sperm concentration and motility were observed after all approaches, but such improvements were observed sooner and showed higher sperm concentration and motility after the use of the microsurgical approaches. Both microsurgical subinguinal and high inguinal approaches yielded comparable success rates, but the operative time and pain control were superior with the high inguinal approach. Because of its favorable safety profile, the microsurgical high inguinal approach should be of value to both experienced microsurgeons and trainees.
手术操作的简便性，以及高成功率和低并发症发生率，对于精索静脉曲张切除术尤为重要。我们比较了在患有精索静脉曲张的不育男性中，经腹膜后、显微外科腹股沟下和高位腹股沟精索静脉曲张切除术的手术参数、并发症发生率和精子参数。本研究纳入了307例患有左侧精索静脉曲张的不育男性，他们分别通过腹膜后途径（n = 43）、显微外科腹股沟下途径（n = 107）或高位腹股沟途径（n = 157）接受了精索静脉曲张切除术。与显微外科手术途径相比，腹膜后途径的手术时间较短（29分钟），而与腹股沟下途径（66分钟）相比，高位腹股沟途径（52分钟）的手术时间明显更短。通过视觉模拟评分评估的疼痛程度以及非甾体类抗炎药的使用情况，在腹膜后途径后最为严重，与腹股沟下途径相比，高位腹股沟途径后的情况明显更好。分别采用腹膜后、腹股沟下和高位腹股沟途径后，患者的复发/鞘膜积液发生率分别为9.3%/9.3%、0.9%/0.9%和1.3%/0.6%。所有手术途径后均观察到精子浓度和活力有显著的术后改善，但显微外科手术途径后这种改善出现得更早，且精子浓度和活力更高。显微外科腹股沟下和高位腹股沟途径的成功率相当，但高位腹股沟途径的手术时间和疼痛控制更佳。由于其良好的安全性，显微外科高位腹股沟途径对经验丰富的显微外科医生和实习生都应有价值。
