Marmar J L, Kim Y
Robert Wood Johnson Medical School, Camden, New Jersey.
J Urol. 1994 Oct;152(4):1127-32. doi: 10.1016/s0022-5347(17)32521-1.
A total of 606 modified subinguinal microscopic varicocelectomies was performed on 466 outpatients using local anesthesia and sedation. The patients selected for these procedures were infertile for at least 12 months and had at least 1 semen parameter below threshold level: less than 20 million per ml., less than 50% motility or less than 40% normal morphological forms. The lymphatics, spermatic artery and vas were preserved, whereas all refluxive veins were transected or obliterated. Postoperative complications were limited to transient epididymal discomfort in 5.5% of the patients, ecchymosis at the wound site in 3.4% and wound inflammation in 2.4%. There was only 1 permanent hydrocele. The palpable recurrence rate was 0.82% per procedure. The median values for each semen parameter were compared preoperatively and postoperatively by the Wilcoxon signed rank test. The differences in the median values were significant for all parameters. As an alternative statistical model, the average preoperative semen value was subtracted from the average postoperative semen value for each parameter. The median differences were 10.8 million sperm per ml. for sperm density, 13.9% for motility and 3.8% for normal morphological forms. These differences were significantly greater than zero by the Wilcoxon signed rank test. The intra-quartile ranges for these differences suggested that postoperatively more than 75% of the patients had a difference of greater than zero for sperm density and per cent motility, and 63% had a difference of greater than zero for normal morphology. The 1-year pregnancy rate was 35.6% for 186 varicocelectomy patients compared to 15.8% for 19 medically treated men with varicocele. The difference between the true 1-year pregnancy rates was 19.8% and the 95% confidence intervals estimated bounds of 1.91 to 37.5%. These data suggest that outpatient subinguinal microscopic varicocelectomy has minimal morbidity and recurrence, and may be beneficial for select patients.
对466例门诊患者采用局部麻醉和镇静进行了总共606例改良腹股沟下显微镜下精索静脉曲张切除术。选择接受这些手术的患者不育至少12个月，且至少有一项精液参数低于阈值水平：每毫升少于2000万个、活力低于50%或正常形态的精子少于40%。淋巴管、精索动脉和输精管予以保留，而所有反流静脉均被切断或闭塞。术后并发症仅限于5.5%的患者出现短暂性附睾不适、3.4%的患者伤口部位出现瘀斑以及2.4%的患者伤口发炎。仅出现1例永久性鞘膜积液。每次手术可触及的复发率为0.82%。术前和术后通过Wilcoxon符号秩检验比较了各精液参数的中位数。所有参数中位数的差异均具有统计学意义。作为另一种统计模型，从每个参数的术后精液平均值中减去术前精液平均值。精子密度的中位数差异为每毫升1080万个精子，活力为13.9%，正常形态的精子为3.8%。通过Wilcoxon符号秩检验，这些差异显著大于零。这些差异的四分位间距表明，术后超过75%的患者精子密度和活力百分比的差异大于零，63%的患者正常形态的差异大于零。186例精索静脉曲张切除术患者的1年妊娠率为35.6%，而19例接受药物治疗的精索静脉曲张男性患者的妊娠率为15.8%。真实的1年妊娠率差异为19.8%，95%置信区间估计范围为1.
