| Objective:In this study,we retrospectively analyzed the patients with varicocele admitted to our department of urology and divided them into two groups: the microscopic group(A)and the retroperitoneal group(B).At the same time,the two groups were analyzed for preoperative and postoperative ultrasonography,semen analysis and follow-up results.And we also discussed the clinical effect of the microsurgery according to the grading of the spermatic vein and semen quality,so as to provide a reference for surgical treatment.Methods:All patients with varicocele admitted to the Department of Urology,Lanzhou University Second Hospital from June 2015 to June 2018 were enrolled.All patients met the inclusion criteria and exclusion criteria,and completed preoperative and postoperative ultrasonography,semen analysis.At the same time,they were followed up for 6 months to 12 months.Testicular volume,semen analysis,long-term complications and spouse pregnancy were collected for statistical analysis.Result:There A total of 70 patients were included,of which 37 patients in group A,accounting for 52.86%;33 patients in group B,accounting for 47.14%.The age range of patients in group A was 19-41 years old,with an average of 27.24 years old,9 patients(about 24.32%)had normal semen quality,and 28 patients(about 75.68%)had abnormal semen quality.The age range of patients in group B was 19-58 years old,with an average of 28.15 years old,9 patients(about 27.27%)had normal semen quality,and 24 patients(about 72.73%)had abnormal semen quality.The postoperative hospital stay was 2.86±0.86 days,and the hospitalization time of B patients was 3.36±1.14 days,P=0.041,and the difference was statistically significant.After operation,total sperm motility,forward sperm movement and sperm density in group A were significantly improved(P < 0.05).In group B,only total sperm motility was significantly increased,and the difference was statistically significant(P < 0.05).Compared with group B,group A was superior to group B in improving forward sperm motility and sperm density(P < 0.05).The sperm motility,sperm forward motion and sperm density were significantly improved in the varicocele I and III degrees,and the difference was statistically significant(P<0.05).When comparing between groups and groups,I degree was better than II degree in improving sperm forward motion,and the difference was statistically significant(P<0.05).The total sperm motility,forward sperm movement and sperm density in asthenospermia group improved significantly after operation(P < 0.05);the total sperm density and sperm number in oligoasthenospermia group improved significantly after operation(P < 0.05).At the same time,in improving forward sperm movement,asthenospermia group was better than oligospermia group and oligoasthenospermia group;and the asthenospermia group was superior to the azoospermia group in improving sperm density.In terms of semen quality improvement,there were 10 cases(about 58.82%)of overall improvement in grade I semen,1 case(about 25.00%)of overall improvement in grade II semen,and 5 cases(about 31.25%)of overall improvement in grade III semen,but there was no statistically significant difference between the groups;the total improvement of semen in oligospermia group was 1 case(about 16.67%),in asthenospermia group was 9cases(about 69.23%)and in Oligoasthenospermia group was 2 cases(about 22.22%).The semen in asthenospermia group was normal in 7 cases(about 53.85%)after operation,and difference between asthenospermia group and other two groups was significant.Conclusion:Compared with retroperitoneal surgery,microsurgery can effectively shorten hospital stay,improve sperm forward movement and sperm density.In patients with degree I varicocele,the improvement of sperm forward movement after operation is better than that of degree II varicocele.For asthenospermia patients,the normal rate of semen parameters and the improvement rate of sperm forward movement and sperm density after operation are higher than those of oligospermatism and Oligoasthenospermia patients.Therefore,when asthenospermia patients are accompanied by varicocele,surgical methods,especially microsurgery,can be chosen to improve semen quality in order to achieve reproductive purposes. |
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