摘要目的:探讨改良的Palomo术和高选择显微镜结扎术对沿海驻防官兵精索静脉曲张（VC）术后生精功能的影响。方法:回顾性分析2016年1月至2023年6月联勤保障部队北戴河康复疗养中心泌尿外科确诊为VC并接受手术治疗的沿海驻防部队官兵126例的临床资料。按照手术治疗方式分为显微组（ n=68）和Palomo组（ n=58），显微组在10倍显微镜下采用高选择显微镜精索静脉曲张结扎术，Palomo组采用改良的Palomo术式。在患者手术前和治疗3、6个月后，采用伟力计算机辅助精子质量分析仪检测2组患者的精子密度、精子总数及a+b级精子数百分率，采用放射免疫法测定2组患者血清卵泡刺激素、黄体生成素及睾丸酮水平，釆用酶联免疫吸附法检测2组患者血清抑制素B水平。 结果:与治疗前比较，2组患者治疗后精子密度、精子总数、a+b级精子数百分率均明显提高，且治疗3、6个月后显微组患者a+b级精子数百分率均明显高于Palomo组（均 P<0.05）。与治疗前比较，2组患者治疗后血清卵泡刺激素、黄体生成素水平均明显降低，睾丸酮、血清抑制素B水平均明显升高（均 P<0.01）；且治疗3、6个月后显微组患者血清卵泡刺激素、黄体生成素水平均明显低于Palomo组，血清抑制素B水平明显高于Palomo组（均 P<0.05）。 结论:高选择显微镜精索静脉曲张结扎术治疗沿海驻防官兵VC能够有效地保护睾丸动脉及淋巴管，明显提高患者的生精功能。

abstractsObjective:To study the effects of modified Palomo surgery and high selectivity microscope ligation on the spermatogenic function of coastal garrison officers and soldiers after varicocele（VC）operation.Methods:A retrospective analysis was conducted on the clinical data of 126 local coastal garrison officers and soldiers who were diagnosed with VC and underwent surgical treatment in Beidaihe Rehabilitation Center of the PLA Joint Logistic Support Force from January 2016 to June 2023. According to the surgical procedure，the patients were divided into a microscopy group（ n=68）and a Palomo group（ n=58）. In the microscopy group，high selectivity microscope varicocele ligation was performed under a 10× microscope，while the Palomo group underwent a modified Palomo procedure. Before surgery and 3 to 6 months after treatment，the sperm density，total sperm count，and percentage of grade a+b sperm count of two groups of patients were measured using a WLJY computer-assisted sperm quality analyzer. The serum levels of follicle stimulating hormone，luteinizing hormone，and testosterone were measured using radioimmunoassay in two groups of patients. The serum levels of inhibin B were measured using enzyme-linked immunosorbent assay. Results:Compared with the data before treatment，the sperm density，total sperm count，and a+b grade sperm count in both two groups significantly increased after treatment（all P<0.05）. After 3 and 6 months of treatment，the percentage of grade a+b sperm in the microscopy group was significantly higher than that in the Palomo group（all P<0.05），Compared with the data before treatment，in both two groups after treatment，the levels of serum follicle stimulating hormone and luteinizing hormone were significantly reduced，while the levels of testosterone and inhibin B were increased（ P<0.01）. After 3 and 6 months of treatment，the serum levels of follicle stimulating hormone and luteinizing hormone in the microscopy group were significantly lower than those in the Palomo group，and serum inhibin B was significantly higher than that in the Palomo group（all P<0.05）. Conclusion:High selectivity microscope varicocele ligation for VC in coastal garrison officers and soldiers can effectively protect testicular arteries and lymphatic vessels and significantly improve the spermatogenic function.