The Clinical Observation Of Laparoscopy And Microscopy In The Treatment Of Varicocele

Objective:compare the clinical effects of laparoscopic high retroperitoneal varicocelectomy(LPV)and microscopic subinguinal varicocelectomy(MSV)in the treatment of varicocele,and evaluate the pros and cons of the two operations on the improvement of semen quality and other aspects.provide a piece of evidence for patients to choose a more suitable minimally invasive surgical treatment.Method:a total of 80 patients were diagnosed as varicocele and hospitalized in the Second Affiliated Hospital of Guangxi Medical University from March 2017 to July 2020 were retrospectively analyzed.They are all cases of a single disease and have not other comorbidities,were divided into laparoscopy group(n=40)and microscopy group(n=40).The body mass index,age,hospitalization days,operation time,bleeding amount,postoperative complications,recurrence rate,semen quality,the improvement of semen quality and symptoms before and 6 months after surgery were analyzed in the two groups.Results:1.There were no statistically significant difference in age,BMI,lesion location,and clinical grading of varicocele between laparoscopy group and microscopy group(P>0.05).2.The mean hospitalization days:microscopy group is(4.83±1.11)days,laparoscopy group is(2.58±0.93)days.The mean operation time:microscopy group is(99.10±27.33)min,laparoscopy group is(42.48±8.30)min.The mean hospitalization expenses:microscopy group is(9190.44±1477.16)yuan,laparoscopy group is(8132.79±1472.55)yuan.Compared with the microscopy group,the laparoscopy group had shorter hospitalization days and operation time,lower hospitalization expenses,the difference was statistically significant(P<0.05).3.The mean blood loss:microscopy group is(5.03±0.89)ml,laparoscopy group is(4.78±0.62)ml,the difference was not statistically significant(P>0.05).4.The improvement in sperm motility,sperm density and the proportion of forward-moving sperm in the microscopy group was significantly higher than that in the laparoscopy group at 6 months after surgery,the difference was statistically significant(P<0.05).Compared to preoperative,the proportion of forward-moving sperm and sperm motility in the two groups were significantly improved at 6 months after surgery,the difference was statistically significant(P<0.05).There was no statistically significant difference in the improvement of sperm density between the two groups at 6 months after surgery(P>0.05).5.There were 3 relapses(3%)in the laparoscopy group,and 0recurrences(0%)in the microscopy group,the difference was not statistically significant(P=0.241),The complication rate of microscopy group was 5.0%and laparoscopy group was 25.0%at 6 months after operation,the difference was statistically significant(χ~2=4.804,P=0.028).6.Select Numerical Rating Scale(NRS)to indicate the improvement of pain symptoms,the mean preoperative NRS score:microscopy group is(3.48±1.04),laparoscopy group is(3.40±0.96),the difference was not statistically significant(P>0.05).Compared to preoperative,the NRS score in the two groups were significantly decreased at 6 months after surgery,and the degree of decline in the microscopy group was significantly better than that of the laparoscopy group,the difference was statistically significant(P<0.05).Conclusion:1.Both microscopic surgery and laparoscopic surgery have a significant effect on the quality of semen and the degree of pain relief,and the improvement range of microscopic surgery is better than that of laparoscopic surgery;2.Compared with the laparoscopy group,the incidence of complications in the microscopy group is lower than that in the laparoscopy group at 6 months after surgery,but there is no significant difference in the recurrence rate,and the microscope group has longer operation time and hospitalization days,and the total hospitalization expenses is relatively higher.