研究目的:精索靜脈曲張是次發性男性不孕患者非常普通的原因，雖然常規的後腹腔或鼠蹊部精索靜脈切除手術已經廣為大家所接受，但是它並不是一個令人滿意的治療方法; 在這裡，我們試圖介紹這個精緻方法和它對不孕病人顯著的好處。材料與方法:從1997年9月到1999年9月，回顧了五十六個或者不孕（36）或者陰囊不適（20）的患者，接受鼠蹊管下方的顯微精索靜脈切除手術，所有病人都採用術前彩色血流杜卜勒超音波確定診斷為精索靜脈曲張; 此外，以Wilcoxon等級測驗統計應用於精蟲變化的比較。結果:在總計上，我們完成了六十七個顯微外科精索靜脈切除手術，在這些病人中，有三十七個（66.1%）是成年人和十九個（33.9%）是青春期的患者，在三十六個（佔五十六個患者的643.3%）的不孕病人中，有8個患者有雙邊精索靜脈曲張，在這三十六個不孕病人中有八個病人（22.2%）是oligospermia，十九個（52.8%）是 asthenospermia，和九個（25%）是oligoasthenospermia。在有疼痛的精索靜脈曲張的二十個（佔五十六個患者的35.7%）病人中，其中3個是雙邊精索靜脈曲張。用顯微精索靜脈切除手術之病人中，在精蟲數目、活動性和形態學上有進步的病人比例，分別是29（80.5%），29（80.5%）和24（66.7%），並且術後病患精蟲數目上增加73.4%，精蟲活動性上改善86.7%，和精蟲的形態上改善84.6%。然而，再發比率是僅僅3%（2/76）。其他相關的併發症包括了血腫1.5%，持續性陰囊的疼痛1.5%，和表面的傷口感染1.5%。結論:在鼠蹊管下方的顯微精索靜脈切除手術是能夠保存睪丸動脈和淋巴引流的一個精緻手術。除了低併發症和再發比率以外，它在精蟲參數的改進上令人振奮的，特別是對精索靜脈曲張導致的不孕患者可以考慮這個方法。

OBJECTIVE: We attempt to introduce this delicate procedure for patients with varicocele and highlight its benefit for infertile patients. MATERIALS AND METHODS: From September 1997 to September 1999, 56 patients with either infertility (36) or scrotal discomfort (20) who underwent subinguinal microsurgical varicocelectomy were reviewed. All patients were confirmed as having varicocele(s) by pre-operative color flow mapping. The Wilcoxon signed rank test was applied for comparison of sperm quality. . RESULTS: In total, 67 varicocelectomies were performed. Of the patients, 37(66.1%) were adults and 19(33%) were adolescents. In 36 infertile patients (64.3% of 57 patients), 8 had bilateral varicoceles. Oligospermial was noted in 8 of the 36 infertile patients (22.2%), 19 (52.8%) had asthenospermia, and 9 (25%) had oligoasthenospermia. In 20 patients (35.7%) who had a painful varicocele, 3 had bilateral varicoceles. Post-operative improvements in sperm count, motility, and morphology of sperm were seen in 29 (80.5), 29 (80.5) and 24(66.7) patients, respectively. Following the procedure, sperm increment rates were 73.4 in count, 86.7% in motility, and 84.6% in morphology. However, the recurrence rate was only 3% (2/67). Other associated complications included hematoma 1.5%, persistent scrotal pain 1.5%, and superficial wound infection 1.5%. CONCLUSIONS: Subinguinal microsurgical varicocelectomy is a delicate procedure that can preserve the testicular artery and lymphatics. In addition to low complication and recurrence rates, its improvements in sperm parameters are promising. This procedure should be considered particularly for infertile patients with varicocele.