目的 探讨精索静脉曲张四种治疗方法的临床疗效.方法 103例精索静脉曲张患者根据不同的治疗方式分为经腹膜后高位结扎术(50例)、精索内静脉转流+高位结扎术(24例)、显微手术(22例)、经皮精索内静脉栓塞术(7例),对其进行术后并发症、术后复发情况、术前术后精液比较等方面进行回顾性分析.结果 术后3个月至半年复诊,出现阴囊水肿和睾丸鞘膜积液2例,均发生在腹膜后高位结扎组,精液分析检查失访6例,有至少一项指标改善者40例,改善率分别在腹膜后组高位结扎组、转流术组、显微手术组、静脉栓塞组为40.00%(16/40)、78.94%(15/19)、61.54%(8/13)、66.67%(4/6,P＜0.05);B超检查失访10例,复发8例,4组分别为24.44%(11/45)、4.54%(1/22)、10.00%(2/20)、0.0%(0/6,P＜0.05).结论 精索内静脉转流+高位结扎术优于其他三种治疗方法,且安全、有效.%Aim To nade a comparative analysis of four kinds of treatments on varicocelectomy. Methods 89 patients with varicocele were divided into 4 groups: retroperitoneal high ligation group( n = 50 ),shunt type group( n = 24 ),microsurgery group( n = 22 )and spermatic vein embolization group( n = 7 ). Postoperative semen quality, recurrence, comnplications in 4 groups were comparatively studied. Results After three months treatment, two complications ( scrotal edema and hydrocele )occurred in the retroperitoneal high ligation group. The rates of semen quality improvement were 40.00％( 16/40 ),78.94％ ( 15/19 ),61.54 ％ ( 8/13 ), and 66.67％ ( 4/6 ). The rates of recurrence were 24.44％ ( 11/45 )、4.54％ ( 1/22 )、 10.00％ ( 2/20 )and 0.0％ ( 0/6 ), respectively, in the retroperitoneal high ligation, shunt surge, microsurge and embolization goups（ P < 0.05 ). Conclusion Using shunt surge of internal spermatic veins is the better therapy on varicocele.
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