Comparative Study On The Clinical Efficacy Of Three Surgical Methods For The Treatment Of Varicocele

Objective: To compare the clinical efficacy of three surgical methods in the treatment of primary varicocele.METHODS: A total of 70 patients with primary varicocele surgery were enrolled in our hospital from 2015 to 2017,including 24 in the microscope group,22 in the magnifying glass group,and 24 in the laparoscopic group.The operation time of the three groups,the number of intraoperative spermatic vein ligation,the number of intraoperative testicular artery retention,the number of(A+B)viable sperm,the improvement of sperm density,the postoperative scrotal discomfort,postoperative complications,postoperative recurrence rate.RESULTS: The operation time of the laparoscopic group was 34.25±11.76 min,which was lower than that of the microscope group,98.17±32.30 min and the magnifying glass group,92.77±36.36min(P<0.05).The number of spermatic vein ligation was 8.25±2.40,which was better than the magnifying glass group 6.45±2.46(P<0.05);the number of spermatozoa(A+B)viable sperm and abnormal sperm density were improved to different degrees after operation.The number of(A+B)Dynamic spermatozoa in the microscope group was 6 months 38.17±5.36% was better than preoperative 19.78±3.73%,and the number of(A+B)Dynamic spermatozoa in the magnifying group was 35.13±3.47% at the 6th month after surgery was better than20.82±3.68% before operation.The number of(A+B)Dynamic spermatozoa in the laparoscopic group was 31.51±3.67% at the 6th month after surgery was better than21.18±4.27% before operation(P<0.05).The sperm density of the microscope group was 23.64±5.87*10^6/ml 6 months after operation,which was better than13.65±6.23*10^6/ml before operation.The sperm density of the magnifying group was22.07±5.21*10^6/ml 6 months after operation,which was better than12.45±6.11*10^6/ml before operation.The sperm density of the laparoscopic group was20.32±3.89*10^6/ml 6 months after operation,which was better than13.22±5.63*10^6/ml before operation(P<0.05).Postoperative scrotal discomfort was relieved.The postoperative remission rate was 83% in the magnifying microscope group,75% in the magnifying glass group,and 67% in the laparoscopic group(P>0.05).Postoperative complications: 1 case of the laparoscopic group showed testicular hydrocele,no postoperative complications occurred in the microscope group and the magnifying glass group(P>0.05).One patient developed recurrence in the laparoscopic group,and there was no recurrence in the microscope group and the magnifying glass group(P>0.05).Conclusion: Laparoscopy assisted high-grade ligation of the spermatic vein,microsurgical low-grade ligation of the spermatic vein,and low-grade ligation of the spermatic vein for the varicocele are effective treatments for varicocele.The indexes of abnormal sperm were improved in different degree after operation.Microsurgical low-grade ligation spermatic vein ligation is the most number for ligation of internal spermatic veins and the best in optimal preservation of testicular arteries.It is superior to laparoscopy assisted spermatic vein ligation and magnifying glass assisted spermatic vein ligation,which is the preferred surgical procedure for varicocele treatment.Magnifying glass assisted spermatic vein low-grade ligation is easy to operate and easy to master.Although it is slightly inferior to microscope-assisted low-grade ligation of the spermatic vein in various clinical effects,it can also achieve a considerable clinical effect.It is recommended that beginners of varicocele surgery pay attention to this type of surgery,which is worthy of promotion in primary hospitals.