Original Article
Comparison of curative effect of different surgical methods on varicocele
Liu Hongzhi, Peng Hua, Li Shuofeng, Xiao Yongshuang, Chen Yue, Li Hailong, Wen Rumin
Published 2020-01-15
Cite as Int J Surg, 2020, 47(1): 35-40. DOI: 10.3760/cma.j.issn.1673-4203.2020.01.008
Abstract
ObjectiveTo compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal single-port laparoscopy and microscopy on varicocele.
MethodsRetrospective 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.
ResultsThe 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, (5 251 ± 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).
ConclusionsMicroscopic 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.
Key words:
Varicocele; Laparoscopes; Microscopy; High varicocele ligation; Comparative effectiveness research
Contributor Information
Liu Hongzhi
Graduate School of Xuzhou Medical University, Xuzhou 221002, China
Peng Hua
Department of Urology, Third People′s Hospital of Xuzhou City, Xuzhou 221002, China
Li Shuofeng
Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
Xiao Yongshuang
Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
Chen Yue
Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
Li Hailong
Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
Wen Rumin
Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China