显微精索静脉结扎术联合地奥司明治疗精索静脉曲张疗效观察

毕罡 龙吟 胡政委

摘要：目的：探討地奥司明在精索静脉曲张（VC）患者进行显微精索静脉结扎术后应用的临床疗效。方法：选择56例VC患者作为研究对象，随机分为药物联合组与对照组各28例。两组患者均采用显微精索静脉结扎手术，在此基础上，药物联合组术后加用地奥司明片治疗。随访观察两组术后治疗效果和相关并发症发生率，并于手术前后应用彩色超声多普勒观察两组患者最大精索静脉内径、静脉返流阳性率。结果：药物联合组和对照组治疗的总有效率相近，两组比较差异无统计学意义。但药物联合组患者术后6个月期间的总体并发症发生率（7.14%）明显低于对照组（17.86%），差异具有统计学意义（P<0.05）;2组术后精液质量明显改善，且药物联合组改善幅度显著优于对照组（P<0.05）;2组术后6个月时最大精索静脉内径以及静脉返流阳性率均显著降低，且药物联合组降低较对照组更明显，差异具有统计学意义（P<0.05）。结论：VC患者进行显微精索静脉结扎术后联合应用地奥司明可以有效减轻术后患者阴囊不适症状，降低并发症发生率，且更好的缩小精索静脉内径，提高精液质量，保证手术治疗效果。

关键词：精索静脉曲张;显微精索静脉结扎术;地奥司明

【中图分类号】R91    【文献标识码】A    【文章编号】2107-2306（2019）04-050-04

Observation on curative effect of microsurgical varicocelectomy with diosmin on varicocele

Bi Gang， Long Yin， Hu zhenwei

Department of Urology， Daping Hospital and Research Institute of Surgery， Army Medical University， Chongqing 400042 ， China

Abstract： Objective  To investigate the clinical effect of diosmin on varicocele （VC） patients after microsurgical varicocelectomy. Methods  56 patients with VC were selected as research objects and randomly divided into drug combination group and control group with 28 cases in each group. Both groups of patients were treated with microsurgical varicocelectomy. And the drug combination group was treated with diosmin tablets after operation. Follow-up observation of the two groups of postoperative treatment effect and the incidence of related complications， and application of color Doppler ultrasound before and after surgery to observe the two groups of patients with the largest spermatic vein diameter， venous reflux positive rates. Results  The total effective rates of the drug combination group and the control group were similar， and there was no significant difference between the two groups. However， the overall complication rate （7.14%） in the drug combination group was significantly lower than that in the control group （17.86%）， and the difference was statistically significant （P<0.05）. The semen quality of the two groups was significantly improved after operation， and the improvement of the drug combination group was significantly better than that of the control group （P<0.05）. The maximum internal diameter of spermatic vein and the positive rate of venous reflux in the two groups decreased significantly at 6 months after operation， and the decrease in the drug combination group was more obvious than that in the control group， the difference was statistically significant （P<0.05）. Conclusion  The combined application of diosmin after microsurgical varicocelectomy in VC patients can effectively reduce scrotal discomfort symptoms， reduce the incidence of complications， and better reduce the internal diameter of spermatic vein， improve semen quality and ensure the surgical treatment effect.

Key words：Varicocele; Microsurgical varicocelectomy; Diosmin

精索静脉曲张（Varicocele）是指由于精索静脉血液回流受阻或瓣膜功能失效等因素，致血液返流引起血液淤滞，精索内蔓状血管迂曲、扩张的疾病。精索静脉曲张是常见的男科疾病，多发于青壮年男性，是造成男性不育的重要因素 ^[1]。该病还常伴有阴囊肿胀、疼痛不适、睾丸萎缩等症状。治疗上多数文献报道以手术治疗为主^[2]，近年来，随着微创外科理念在泌尿外科领域的推广，显微精索静脉结扎术在临床得到广泛认同，但其术后仍存在不同程度的并发症，其原因与术后微静脉扩张、淋巴回流受阻等情况有关。地奥司明片是一种天然黄酮类衍生物，既往研究显示其具有抗炎、抗渗出以及恢复静脉管壁弹性、改善微循环等作用，对于各种慢性静脉功能不全的疾病具有较好疗效^[3]。……