Wang Xiaobin, Wang Ruipeng, Du Qiang, Pan Bochen
Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
Transl Androl Urol. 2021 Oct;10(10):3862-3872. doi: 10.21037/tau-21-908.
Varicocele (VC) is one of the most common causes of infertility in men, and microscopic varicocelectomy is currently the major surgical procedure for VC. We assessed the clinical effectiveness of microsurgical subinguinal varicocelectomy (MSV) with enhanced recovery after surgery (ERAS) in the treatment of VC in terms of semen quality improvement rate, pregnancy rate, pain relief rate, recurrence rate, and complication rate after MSV and explored the indications for VC surgery.
In total, 216 patients undergoing MSV in our center between June 2019 and July 2020 were enrolled in this study. All patients received the surgery under local anesthesia and were admitted and discharged within 24 hours. All patients were followed up for more than 6 months, and the rates of semen quality improvement, pregnancy, pain relief, recurrence, and postoperative complications were recorded. We can evaluate the pain degree of patients through the numerical rating scale (NRS). (I) 0 points for painless; (II) 13: mild pain; (III) 46: moderate pain; (IV) 710 points are severe pain. 0 is the most slightly, indicating comfort, and 10 is the most painful and unbearable.
The sperm concentration, total sperm count, progressive motility rate, sperm viability, and morphology were significantly improved after the surgery (all P values <0.05). The rate of semen quality improvement was 88.2%, and the semen indicators returned to normal in 26.6% of the patients. Among the patients who were followed up for 1 year, the natural conception rate reached 27.1% and was accompanied by a 95.5% pain relief rate, a 0.5% VC recurrence rate, and a 2.3% postoperative complication rate.We obtained data through laboratory examination of semen DNA fragments index (DFI). Compared with preoperative and postoperative DFI, postoperative DFI was improved, and the pregnancy outcome was improved.
MSV under local anesthesia increases the rates of semen quality improvement, pregnancy, and pain relief while lowering the rates of recurrence and postoperative complications. MSV may also help to improve the pregnancy outcomes in patients with VC accompanied by sperm DNA fragmentation or nonobstructive azoospermia, but this should be verified by further investigation.
精索静脉曲张（VC）是男性不育的最常见原因之一，显微精索静脉结扎术是目前治疗VC的主要外科手术。我们从精液质量改善率、妊娠率、疼痛缓解率、复发率和显微精索静脉结扎术后的并发症发生率方面评估了采用术后加速康复（ERAS）的显微腹股沟下精索静脉结扎术（MSV）治疗VC的临床疗效，并探讨了VC手术的适应证。
本研究纳入了2019年6月至2020年7月在我院中心接受MSV的216例患者。所有患者均在局部麻醉下接受手术，并在24小时内入院和出院。所有患者均接受了超过6个月的随访，并记录了精液质量改善、妊娠、疼痛缓解、复发和术后并发症的发生率。我们可以通过数字评分量表（NRS）评估患者的疼痛程度。（I）无痛为0分；（II）1～3分为轻度疼痛；（III）4～6分为中度疼痛；（IV）7～10分为重度疼痛。0为最轻微，代表舒适，10为最疼痛且无法忍受。
术后精子浓度、总精子数、前向运动率、精子活力和形态均有显著改善（所有P值均<0.05）。精液质量改善率为88.2%，26.6%的患者精液指标恢复正常。在接受1年随访的患者中，自然受孕率达到27.1%，疼痛缓解率为95.5%，VC复发率为0.5%，术后并发症发生率为2.3%。我们通过精液DNA碎片指数（DFI）的实验室检查获得数据。与术前和术后DFI相比，术后DFI有所改善，妊娠结局也得到改善。
局部麻醉下的MSV提高了精液质量改善率、妊娠率和疼痛缓解率，同时降低了复发率和术后并发症发生率。MSV可能还有助于改善伴有精子DNA碎片或非梗阻性无精子症的VC患者的妊娠结局，但这一点有待进一步研究证实。
