| BackgroundVaricocele (Vc) is one of the clinically common diseases in urology and has become a major cause of male infertility. Patients with varicocele often have varying degrees of abnormal semen parameters, pain and scrotum bulge. The World Health Organization has taken varicocele as the primary causes which affect male infertility during its study. The ideal treatment of Vc should be safe, effective and minimally invasive. However, there are plenty of debates about which treatment method is the best because of various treatments’ different characteristics.ObjectiveAuthor of this article aims to analyze the basic and key facts of patients with left varicocele who had visited The Third Affiliated Hospital of Xinxiang Medical College during February 2013 to December 2014 as well as the prognosis situations of varicocelectomy under laparoscopic surgery, internal spermatic vein ligation under the microscope and percutaneous varicocele embolization. This also includes the retrospective analysis of fundamental facts related to patients in terms of the operation time, total hospitalization time, scrotal edema, rate of postoperative recurrence, semen quality improvement after surgery and changes of testicular volume. After comparing the efficacy of three different treatment methods (laparoscopic varicocele ligation, microscopic spermatic vein ligation, percutaneous varicocele embolization), this article explores the best way of minimally invasive surgical varicocele treatment. At the same time, this also provides patients with guideline to choose a suitable treatment method for themselves.MethodsAuthor of this article collect and retrospectively analyze the data of 70 cases of patients who had visited the third Affiliated Hospital of Xinxiang Medical College during 2013.2-2014.12, including 30 cases of laparoscopic surgery,30 cases of microsurgery and 10 cases of interventional treatment. All these cases were not merged with other diseases and were without history of left retroperitoneal or pelvic area surgery. This article focuses on the patients who come from the department of urology and reproductive center and age from 23-35 years old (average age is 28.89±3.75 years old). These patients include some have the symptoms of scrotum bulge, pain, infertility after marriage (not taking any contraceptive measures for more than a year of normal sexual activities and partner not able to conceive) and a few were without any symptom but diagnosed during their physical examinations. Among these cases, there are 35 cases of scrotum bulge and pain,19 cases of infertility and 16 cases without any signs during physical examination,42 cases of 2nd degree Varicocele and 28 cases of 3rd degree Varicocele. All these patients underwent routine ultrasound examination (to measure varicocele grade and testicular volume), and routine semen examination before the surgery.Results1. The subjects’ age, body mass index (BMI) in these three study groups were not statistically significant (P>0.05)2. The average time:laparoscopic surgery group is (43.13±3.50) min, microscopic group is (63.13±9.70) min, the intervention group is (37.10 ± 2.13) min. The time of the microscope surgery was significantly longer than that of laparoscopic group and the intervention group. The difference was statistically significant (P 0.05).3. The average hospitalization time:laparoscopic group is (6.30±0.88) days, microscopes group is (4.17 ± 0.79) days, the intervention group is (3.20 ± 0.79) days. The total hospitalization time of the laparoscopic group is more than that of the microscopic group and intervention group. The difference was statistically significant (P<0.05).4. Postoperative scrotal edema (6 months follow-up after surgery):2 cases in laparoscopic group (6.6%),0 cases in microscope group,0 cases in intervention group. The differences among three groups were statistically significant (P<0.05).5. Relapse (6 months follow-up after surgery):1 case in the laparoscopic group (3.3%),0 case in microscopic group and intervention group. The difference was not statistically significant (P> 0.05).6. The analysis on semen of pre and post treat during the 6 months period:there was no statistically significance of the difference in semen parameters among three groups before surgery; the index of semen of three groups had been significantly improved after surgery (P<0.05); there was no statistically significance of the difference in semen parameters among three groups after surgery.7. The average volume of testis in three groups was larger than before. The differences among three groups were statistically significant (P> 0.05).Conclusion1. Though the operation time of microscopic surgery is long, it has advantages over laparoscopic surgery in terms of recurrence rate, scrotal edema, and hospitalization time. Also, little trauma and quicker recovery make microscopic surgery be more acceptable by patients.2. The operation time and hospitalization time of interventional surgery is shorter but patients need to be placed under continuous irradiation during surgery. Therefore, it’s not easy to be accepted by patients.3. Laparoscopic surgery does not have obvious benefits because of the longer operation time and hospitalization time, the higher recurrence rate and the need of general anesthesia. However, it can resolve bilateral problems in one surgical incision. |
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