背景:腹股沟下镜下结扎是目前治疗精索静脉曲张的标准,经皮栓塞是一种新的选择。我们旨在比较这些程序的生殖和功能方面。
方法:连续76例临床精索静脉曲张患者,精液参数的改变和不育,术前和术后(1,3,6,9和12个月)进行任一手术(49例显微手术和27例栓塞)的前瞻性分析.结果指标是:精液参数,怀孕,疼痛,副作用,恢复时间和总体满意度。随后,我们于2015年1月通过电话联系了所有患者(手术后中位延迟4年),以确定生殖事件.
结果:术前,两组的临床和生物学项目相同.我们观察到精子浓度在3、6、9和12个月(分别为P<0.001、<0.001、0.012、0.018)和精子活力在6个月(P=0.002)时有所改善。PE组6个月时精子浓度较高(P=0.043)。手术后的中位随访时间为4年,发生27例妊娠(自发妊娠率为32%)。精子质量上的程序没有差异,妊娠率和总体满意度。接受经皮栓塞的患者报告了更快的恢复时间(P=0.002)和更少的术后疼痛(P=0.007)。
结论:两种方法在精子质量方面都给出了相同的结果,妊娠率和满意度,尽管经皮栓塞后恢复似乎更快,术后疼痛似乎更低。
方法:4.
BACKGROUND: Subinguinal microscopic ligation is the current standard of treatment of varicocele, and percutaneous embolization is a new alternative. We aimed to compare these procedures for reproductive and functional aspects.
METHODS: A consecutive series of 76 patients with clinical varicocele, alteration of semen parameters and infertility, undergoing either procedure (microsurgery in 49 cases and embolization in 27 cases) was prospectively analyzed preoperatively and postoperatively (at 1, 3, 6, 9 and 12 months). Outcome measures were: semen parameters, pregnancies, pain, side effects, recovery time and overall satisfaction. Subsequently, all patients were contacted by telephone in January 2015 (with a median delay of 4 years after the procedure) in order to determine reproductive events.
RESULTS: Preoperatively, both groups were identical for clinical and biological items. We observed an improvement of sperm concentration at 3, 6, 9 and 12 months (P<0.001, <0.001, 0.012, 0.018, respectively) and sperm motility at 6 months (P=0.002). The sperm concentration was higher at 6 months in PE group (P=0.043). With a median follow-up of 4 years after the procedure, 27 pregnancies occurred (spontaneous pregnancy rate of 32%). There was no difference between procedures on the sperm quality, pregnancy rate and the overall satisfaction. Patients undergoing percutaneous embolization reported a faster recovery time (P=0.002) and less postoperative pain (P=0.007).
CONCLUSIONS: Both procedures give equivalent results regarding sperm quality, pregnancy rate and satisfaction even though recovery seems faster and postoperative pain seems lower after percutaneous embolization.
METHODS: 4.