Cao Xu, Tian Cheng, Feng Wei, Zhu Shu-Xian, Chen Kai, Zheng Yu-Hang, Yao Jian-Zhong
Department of Urology, 920th Hospital of Joint Logistic Support Force, Kunming, 650000, China.
Chinese PLA Medical School, Beijing, 100853, China.
BMC Urol. 2024 Dec 21;24(1):277. doi: 10.1186/s12894-024-01670-x.
To analyze the safety and efficacy of microsurgical subinguinal varicocelectomy(MSV) performed with and without preservation of all testicular arteries and lymphatic system.
All of the 98 patients with varicocele who underwent MSV were included in the analysis. Fifty-eight male patients surgically underwent MSV with preservation of all testicular arteries and lymphatic system(Group 1). The other 40 male patients surgically underwent MSV with preservation of a single testicular artery, while the remaining vascular bundle sparing the vas deferens with its vessels was then isolated"en bloc," ligated and cut(Group 2). Operative time, semen parameters and complications were then compared.
Mean operative time for Group 1 was significantly longer than that of Group 2(90.26 ± 21.69 min vs. 79.30 ± 19.58 min, P = 0.01). Visual analogue pain scale (VAS) decreased significantly in both groups. Group 1 experienced a decrease from a median of 5 (interquartile range, IQR: 4 ~ 6) to 1 (IQR: 0 ~ 2), P < 0.001; similarly, Group 2 saw a reduction from a median of 4 (IQR: 3 ~ 5.75) to 1 (IQR: 1 ~ 2), P < 0.001. Additionally, notable improvements were recorded in sperm count and motility in both groups at the 12-month follow-up compared to their pre-operative measurements. For Group 1, sperm count increased from a median of 35.5 × 10/mL(IQR: 29 ~ 60) to 60 × 10/mL(IQR: 50 ~ 74.25), and motility from 46.5% (IQR: 32 ~ 56%) to 69%(IQR: 54.5 ~ 79%), both with P < 0.001. Group 2 showed similar enhancements, with sperm count rising from a median of 31 × 10/mL (IQR: 20 ~ 56.25) to 57.5 × 10/mL(IQR: 51.25 ~ 73.75) and motility from 44% (IQR: 23 ~ 54.75%) to 75% (IQR: 51.25 ~ 80%), P < 0.001. The duration of postoperative hospital stay was comparable between the two groups, with both reporting a median stay of 3 days (IQR: 2-3 days, P = 0.83). No testicular atrophy and varicocele recurrence was observed in all patients. The incidence rates of hydrocele, wound infection, and orchitis and epididymitis showed no significant disparity between the two groups. Specifically, both groups each had a single incidence of hydrocele. Group 1 had one incidence of wound infection, while Group 2 had none. Orchitis and epididymitis occurred once in Group 1, but not in Group 2.
Our study provides preliminary evidence supporting the implementation of the"en bloc" procedure in MSV as a potentially safe and effective option, especially for managing cases with severe adhesion.
分析保留或不保留所有睾丸动脉及淋巴系统的显微外科腹股沟下精索静脉结扎术（MSV）的安全性和有效性。
纳入98例行MSV的精索静脉曲张患者进行分析。58例男性患者接受保留所有睾丸动脉及淋巴系统的MSV手术（第1组）。另外40例男性患者接受保留单条睾丸动脉的MSV手术，然后将保留输精管及其血管的其余血管束“整块”分离、结扎并切断（第2组）。随后比较手术时间、精液参数和并发症。
第1组的平均手术时间显著长于第2组（90.26±21.69分钟对79.30±19.58分钟，P = 0.01）。两组的视觉模拟疼痛量表（VAS）均显著下降。第1组从中位数5（四分位间距，IQR：4～6）降至1（IQR：0～2），P < 0.001；同样，第2组从中位数4（IQR：3～5.75）降至1（IQR：1～2），P < 0.001。此外，与术前测量值相比，两组在12个月随访时的精子计数和活力均有显著改善。第1组精子计数从中位数35.5×10⁶/mL（IQR：29～60）增至60×10⁶/mL（IQR：50～74.25），活力从46.5%（IQR：32～56%）增至69%（IQR：54.5～79%），两者P均< 0.001。第2组有类似改善，精子计数从中位数31×10⁶/mL（IQR：20～56.25）增至57.5×10⁶/mL（IQR：51.25～73.75），活力从44%（IQR：23～54.75%）增至75%（IQR：51.25～80%），P < 0.001。两组术后住院时间相当，均报告中位数住院时间为３天（IQR：2～3天，P = 0.83）。所有患者均未观察到睾丸萎缩和精索静脉曲张复发。两组在鞘膜积液、伤口感染、睾丸炎和附睾炎的发生率上无显著差异。具体而言，两组各有1例鞘膜积液发生。第1组有1例伤口感染，第2组无。第1组发生1次睾丸炎和附睾炎，第2组未发生。
我们的研究提供了初步证据，支持在MSV中实施“整块”手术作为一种潜在安全有效的选择方案，特别是用于处理粘连严重的病例。
