经腹股沟入路与腹股沟外环下切口入路显微精索静脉结扎术治疗青少年精索静脉曲张的有效性和安全性比较

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Comparison of the efficacy and safety of inguinal and subinguinal approaches for microsurgical varicocelectomy in the treatment of adolescent varicocele

HUANG Yuanbiao KANG Huayin LI Zhigang GUO Chaoyong BAI Bing2

ABSTRACT：Objective To compare the degree，efficacy and safety of testicular catch-up growth after inguinal and subinguinal surgery for adolescent varicocele. Methods Clinical data of 121 adolescent varicocele patients with secondary testicular atrophy treated during Sep.2014 and Jun.2021 at Huili People＇s Hospital were retrospectively analyzed，including 40 cases treated with the inguinal incision approach，and 81 with the subinguinal approach. The characteristics of intraoperative， efficacy，surgical complications and prognosis were compared between the two groups. Results The inguinal group had significantly shorter microscope usage time （P=0.006），fewer number of preserved internal spermatic arteries （P＜0.001），and significantly larger diameter of preserved internal spermatic arteries than the subinguinal group （P=0.005）. The subinguinal group required ligation of more internal spermatic veins，and there were significantly more internal spermatic veins with a diameter of 4 mm or more （P＜0.001）. No recurrence occurred，and the incidences of scrotal edema and hydrocele were very low （P＞0.05）. Two years after surgery，the bilateral testicular volume of both groups was significantly larger than that before surgery （P＜0.05），and there was no significant difference in the testicles （P＞0.05）. Conclusion In the treatment of adolescent varicocele patients with secondary testicular atrophy，the subinguinal approach significantly reduces the difficulty of microsurgical varicocele ligation，and has good efficacy and safety，which is worthy of clinical promotion and application.

KEY WORDS：varicocele；adolescent；microsurgery；surgical approach；secondary atrophy of testicles；inguinal incision approach；subinguinal approach

摘要：目的 比较经腹股沟与腹股沟外环下切口两种手术入路的显微精索静脉结扎术治疗合并睾丸继发性萎缩的青少年精索静脉曲张术后睾丸追赶性生长情况、疗效及安全性。（剩余7734字）