ABSTRACT
Objective To compare the curative effect of three different surgical
methods:
peritoneal
varicocele ligation,peritoneal single-port
laparoscopy and
microscopy on
varicocele.
Methods Retrospective
analysis of the case data of 150
patients with
varicocele treated in the Affiliated
Hospital of Xuzhou Medical
University from September 2016 to September 2018.The average age was 24.5 years,and the age range was 22-30 years.The
patients were divided into three groups according to different surgical
methods:
open group,
laparoscopy group and microscope group,with 50 cases in each group.
Patients in the open group were treated with retroperitoneal
spermatic cord ligation.
Patients in the laparoscopic group were treated with single-hole laparoscopic
laparoscopic surgery.
Patients in the microscope group were treated with microscope
surgery.Operation
time,postoperative
hospitalization time,
hospitalization cost reserved
arteries,surgical
complications (such as
testicular hydrocele,scrotal
edema,
epididymitis,testicular
atrophy),
recurrence,and
semen quality improvement were compared between three groups.Measurement data were expressed as mean ± standard deviation(Mean ± SD),the two comparisons used the t test,the comparison between the three groups used the
analysis of variance,and the comparison between the count data groups using the
Chi-square test.Results The operation
time of the
patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60 ± 3.69) min] and the laparoscopic group [(39.54 ± 2.87) min].The difference between the two groups was statistically significant (P < 0.05);but the postoperative
hospitalization time and
hospitalization cost of
patients in the microscope group [(2.16±0.95) d,(5251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d,(64 75 ±415) yuan)] and the laparoscopic group [(3.28 ± 1.01) d,(7 379 ± 273) yuan].The results of pairwise comparison showed that the difference between the microscope group,the open group and the laparoscopic group was statistically significant (P <0.05).Arterial preservation in the microscope group [47(94.0%)] were compared with the open group [35 (70.0%)],and laparoscopic group [30(60.0%)] had obvious advantages.Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P < 0.05).After follow-up for six months,2 cases were
lost to follow-up in the microscope group,1 cases were lost to the open group,and 5 case was lost to the unilateral laparoscopic group.2(4.2%)
patients had
complications in the microscope group,and 14 (28.6%)
patients had
complications in the open group;9 (20.0%)
patients had
complications in the laparoscopic group,and the total
incidence of
complications showed a pairwise comparison,the difference between the microscope group,the open group and the laparoscopic group was significant (P < 0.05).The
recurrence rate in the microscope group was 2.1% (1/48),the
recurrence rate in the open group was 18.4% (9/49),and the
recurrence rate in the laparoscopic group was 13.3% (6/45);the
recurrence rate was compared in pairs,the difference between the microscope group,the open group and the laparoscopic group was significant (P < 0.05).The improvement rate of
semen quality in the microscope group was 68.8% (33/48),the open group was 42.9% (21/49),the laparoscopic group was 55.6% (25/45),pairwise comparison results showed that the microscope group compared with the open group and
laparoscopy group,the difference were statistically significant (P < 0.05).Conclusions Microscopic
surgery has less
trauma,faster postoperative recovery,shorter operation
cost and
hospitalization time.
Postoperative complications and
recurrence,and improved
semen quality are all superior to open spermatic
vein ligation and single-hole umbilical
laparoscopic surgery,it is a safe and effective way to treat
varicocele.