| Objective:To explore the clinical effect of laparoscopic varicocele ligation by preserving testicular artery for the treatment of varicocele,and compare to laparoscopic varicocele vascular cluster ligation.Methods:69 cases of infertile patients with varicocele from January 2014 to December 2016oftheFirstHospitalofShanxiMedicalUniversitywereanalyzed retrospectively.According to the surgical method,the patients were divided into two groups:group A:36 cases were reserved for the testicular artery,group B:33 cases were ligated by the cluster of spermatic vessels.The sperm quality improvement,natural fertility rate,postoperative complication rate and recurrence rate were compared between the two groups,and the clinical effects of the two surgical methods were analyzed and evaluated.Results:All 69 cases were successfully operated.(1)Semen parameters improvement:(1)GroupA:preoperativespermdensity(23.6±7.52)×10~6/ml,spermmotility(a+b%)for(22.81±8.35),threemonthsaftersurgery,thespermdensitywas(35.65±10.66)×10~6/ml,sperm motility(a+b%)for(43.01±14.87),The difference was statistically significant compared with the preoperative(P<0.01),showed significant improvement in the quality of semen.(2)Group B:preoperative sperm density(23.20±6.33)×10~6/ml,sperm motility(a+b%)for(22.55±7.83),three months after surgery,the sperm density was(28.81±6.64)×10~6/ml,sperm motility(a+b%)for(32.28±13.02),The difference was statistically significant compared with the preoperative(P<0.01),showed that the semen quality also improved significantly.(3)The two groups were compared,group A:36 cases were retained of the testicular artery,and the sperm density increased in 25 patients.Group B:33 cases of spermatic vascular cluster ligation,and 15 patients had increased sperm density.The difference between the two groups was statistically significant(P=0.044).The results showed that the sperm density in the reserved testis artery group was better than that of the semen vessel cluster ligation.The preserving testicular artery group was retained in 36 cases,and the sperm motility was improved in 30 cases.33 cases of spermatic vascular cluster ligation were performed,and 20 cases of sperm motility were improved.The difference between the two groups was statistically significant(P=0.035).The results showed that the spermatozoa viability of the laparoscopic preserving testicular artery group was significantly better than that of the laparoscopic spermatic vascular cluster ligation group.(2)Natural fertility:there were 17 cases of natural birth in group A,and 8 cases in group B had natural birth.The difference between the two groups was statistically significant(P=0.047).The results showed that the natural fertility rate of preserving testicular artery group was higher than that of spermatic vascular cluster ligation group.(3)Complications:in group A,there were 3 cases of hydrocele in the testis and 3 cases of the hydrocele in group B.The difference between the two groups was not statistically significant(P=0.911).There was no testicular atrophy in group A,and there were 1 cases of testicular atrophy in group B.The difference between the two groups was not statistically significant(P=0.293).There were 1 cases of relapse in group A and 2 cases in group B.The difference between the two groups was not statistically significant(P=0.051).Conclusion:the sperm quality recovery and natural fertility of the reserved testicular artery group are superior to those of the spermatic vessel cluster ligation group.There was no significant difference in the hydrocele of the testicle,atrophy of the testis and the recurrence of varicocele between the two methods.Therefore,for the infertile patients with varicocele,the testicular artery should be preserved as far as possible during laparoscopic surgery,so as to maximize the protection of testicular function,promote the recovery of sperm quality and improve the natural conception rate after operation.This more accurate method of operation should be applied to the treatment of varicocele. |
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