| Aims: To evaluate the therapy effects of two different surgical approaches to varic oceletomy by comparing their preoperative and postoperative semen quality changes,the incidence of postoperative complications,recurrence rate of varicocele and the infertility rate of infertile patients,which divided into laparoscopy group and microsurgery group.To provide reference for the selection of surgical methods in the treatment of varicocele.Methods: A total of 90 patients with grade 2 and grade 3 primary varicocele who were treated in our hospital from June 2015 to June 2016 were enrolled in this study,these patients were aged 17-36 years,with a mean age of(26.95±3.39)years old.The patients were divided into two groups according to the operation mode: laparoscopy group(group A)and microsurgery group(group B),there were 45 patients in each group.All of the patients were examined semen analysis to observe the changes of semen quality parameters such as sperm density,sperm count,(a+b)grade sperm ratio,postoperative follow-up of patients with postoperative complications,recurrence rate,pregnancy rate of spouse.All data was analyzed by statistic methods.Results: 1.There was no significant difference in sperm density between the two groups at different time points after operation(F1=0.400?P1=0.528;F2=0.170?P2=0.681;F3=0.140?P3=0.906).The increase of sperm density of two groups was not statistic ally significantly between preoperative and 6 months after the surgery(F=0.078,P=0.781).2.There was no significant difference in sperm count between the two groups at different time points after operation(F1=0.950?P1=0.332;F2=1.251?P2=0.266;F3=1.375?P3=0.244).The increase of sperm count of two groups was not statistically significantly between preoperative and 6 months after the surgery(F=1.342,P=0.250).3.There was no significant difference in(a+b)grade sperm ratio between the twog roups at different time points after operation(F1=0.400?P1=0.528;F2=0.170?P2=0.681;F3=0.140?P3=0.906).The increase of(a+b)grade sperm ratio of two groups was not statistically significantly between preoperative and 6 months after the surgery(F=0.078,P=0.781).4.There were 10 cases of hydrocele and scrotal swelling,and 5 cases of recurrence occurred in group A after the operation,while the group B has only one scrotal swelling,the difference was statistically significant(?21=8.389??22=5.294,P1=0.004?P2=0.021).After 1 year of follow-up,the pregnancy rate of the patients in the group A was 6/34(17.65%),while it was 14/33(42.42%)in group B,the difference was statistically significant(?2=4.910,P=0.027).5.In group A,the mean fasting time was(22.96±1.68)hours,while the mean time of the B group was(5.40±0.81)hours.The fasting time of group A was significantly higher than that of group B,the difference was statistically significant(F=13.624,P=0.000)The average length of stay in hospital of group A was(4.38±0.49)days,while it was(1.24±0.35)days in group B,the average length of stay in hospital of group A was significantly longer than that in group B,the difference was statistically significant(F=7.168,P=0.009).Conclusions: 1.The results showed that both microsurgery and laparoscopic surgery can effectively improve the quality of semen,it means that patients with abnormal semen quality should be treated surgically.2.Microsurgical treatment of varicocele can reduce postoperative complications and reduce recurrence rate.3.Microsurgical operation also has the advantages of less surgical trauma,high pregnancy rate and no influence on aesthetics,it is worth popularizing in clinic.4.Patients undergoing microsurgery have a fewer hospital days and the time of fasting were shorter,which was more consistent with the concept of enhanced recovery after surgery. |
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