腹腔鏡精索全靜脈曲張結紮術和腹腔鏡選擇性精索靜脈曲張結紮術之比較

林敬哲、施冠偉、戴定恩、周安琪、蔡曜州

台北醫學大學附設醫院泌尿科

Laparoscopic en mass versus elective internal spermatic vein ligation technique for varicocele

Ching-Che Lin¹, Kuan-Wei Shi, Ting-En Tai, An-Chi Chou, Yao-chou Tsai^1,2

¹Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan

²Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

Purpose: The aim of this study was to compare outcome measures between laparoendoscopic en mass ligation and selective spermatic vein ligation technique for varicocele

Materials and Methods: Between March 2010 and October 2019, a total of 51 patients underwent laparoscopic varicocelectomy were retrospective reviewed. Of these, 31 patients underwent en mass ligation(group 1) technique and 20 patients underwent selective spermatic vein ligation technique(group 2). Peri-operative outcome, post-operative testes volume, peri-operative semen analysis were compared beteween the two groups.

Results: There was no significant difference in baseline characteristics such as age, body mass index, varicocele grading. No significant differences were found between group 1 and group 2 with the respect to the operative time(51.16±22.82, 59.52±16.12minutes, respectively, p=0.057), left testis size(19.01±5.49, 19.13±4.92, respectively, P=0.86),right testis size(19.18±5.19, 19.34±4.66 mL, respectively, P=0.88), Hormone profile(such as FSH level, testosterone level), VAS score. Significant difference was found with the respect of semen concentration(post-operative 3 months)(427.69±435.55, 1076.67±443.20 *10^5/cc respectively, P<0.05), but no significant difference was found between 2 groups afterwards at 6 months follow-up in semen concentration.   

Conclusions:

The findings of the present study suggest that en mass ligation is as safe as selective spermatic vein ligation technique for varicocele. We found that early recovery of semen concentration at 3-month follow-up. Furthermore, post-operative semen motility and concentration after 6 months of follow-up also showed no significance. Operative techniques were based on the surgeon’s preference in our study. Further randomized study is mandatory for our study.