腹腔镜下保留精索内动脉的精索静脉高位结扎术700例总结报告

目的评价腹腔镜保留精索内动脉的精索静脉高位结扎术的效果及价值。方法回顾分析自2007年1月至2014年1月在我科室应用钛夹、超声刀、丝线结扎等不同方式行腹腔镜下保留精索内动脉的精索静脉高位结扎术患者700例的临床资料,探讨腹腔镜下保留精索内动脉的精索静脉高位结扎术的安全性及有效性,并对治疗效果、并发症及手术经验等进行总结分析。结果 700例精索静脉曲张患者,年龄16~46岁(平均27岁);其中单侧精索静脉曲张患者482例,双侧精索静脉曲张患者218例,均采用腹腔镜行双侧精索静脉高位结扎术,术中均分离并保留双侧精索内动脉。其中钛夹组患者150例,超声刀组患者200例,丝线结扎组患者350例。手术时间30分钟~60分钟,平均手术时间43分钟;住院时间3~5天。术后患者均取得较满意治疗效果,阴囊坠胀不适感明显改善,不育患者复查精液显示精子质量较术前明显提高。术中出现皮下气肿患者18例,术后出现睾丸鞘膜积液者12例,睾丸炎者8例,术后复发者5例,均经保守治疗或二次手术后治愈。无输精管损伤、睾丸萎缩病例发生。结论腹腔镜保留精索内动脉的精索静脉高位结扎术能更大限度保留睾丸血供,具有简便、微创、并发症少、效果可靠、术后恢复快等的优点,尤其适用于双侧精索静脉曲张、具有腹股沟区手术史、术后复发等患者,是治疗精索静脉曲张的有价值的方法,可作为手术治疗的首选方式。     

腹腔镜保留睾丸动脉的精索静脉高位结扎术（附43例报告）

目的评价腹腔镜保留睾丸动脉的精索静脉高位结扎术的效果及价值。方法回顾性分析2004年7月至2008年7月共43例腹腔镜下保留睾丸动脉的静索静脉高位结扎术的临床资料，其中左侧12例，右侧5例，双侧26例。结果43例手术均成功，平均手术时间单侧25min，双侧38min。术中无大出血和肠管损伤等并发症，术后住院3—4d。随诊6—12个月，无复发及睾丸萎缩。结论腹腔镜保留睾丸动脉的精索静脉曲张高位结扎术创伤小，效果好，尤其适合双侧精索静脉曲张患者。     

保留与不保留精索内动脉对治疗精索静脉曲张的疗效比较

目的观察腹腔镜手术保留与不保留精索内动脉对治疗精索静脉曲张的临床疗效,比较两种术式的优劣。方法将2011年7月至2012年8月在我院住院治疗的68例精索静脉曲张患者随机分为A、B两组,两组患者均实施经腹腔镜双侧精索静脉高位结扎术,A组术中保留精索内动脉,B组术中对双侧精索内静脉连同动脉集束结扎。分析比较两组的手术时间、并发症、疗效等。结果 68例患者均顺利完成,术后1个月复查症状均消失,曲张的静脉均明显缩小或消失。随访1年两组均无复发,均未发现睾丸萎缩,A组出现睾丸鞘膜积液2例,B组1例。A组手术时间明显长于B组(P0.05),在精液质量改善方面A组优于B组,在术后住院时间、术后并发症方面,两组差异无显著性(P0.05)。结论腹腔镜下精索内静脉高位结扎术保留精索内动脉比不保留精索内动脉有优势,在技术允许的情况下应尽量保留精索内动脉。     

腹腔镜下保留睾丸动脉的精索静脉高位结扎术

目的 探讨腹腔镜下保留睾丸动脉的精索静脉高位结扎术的应用价值.方法 2009年5月~2013年3月,对双侧精索静脉曲张21例,腹腔镜下行保留睾丸动脉的双侧精索静脉高位结扎术,术中使用冷器械,先于内侧分离出睾丸动脉,再整体游离并结扎血管束余部.结果 21例手术均顺利完成,无中转开放,术中出血〈10 ml,手术时间（45.2±14.5）min,术后6 h下床活动并恢复饮食,术后伤口疼痛轻微,均无须使用镇痛药物,术后3个月精子密度及活力提高13例（76%,13/17）,阴囊胀痛消失15例（93%,15/16）.随访3~50个月,平均25个月,无睾丸鞘膜积液、睾丸萎缩.结论 腹腔镜下单纯冷器械行保留睾丸动脉的精索静脉高位结扎术安全、可靠,具有微创的优势.     

腹腔镜和显微镜下精索静脉结扎术的比较

目的比较腹腔镜精索静脉高位结扎术和显微镜精索静脉结扎术治疗精索静脉曲张的疗效。方法将66例精索静脉曲张患者分成两组,37例行腹腔镜精索静脉高位结扎术(腹腔镜组),29例行显微镜精索静脉结扎术(显微镜组)。对比两组患者手术所用时间、术中睾丸动脉保护、术后睾丸鞘膜积液的发生、精液质量的改善、复发率。结果两组手术时间、术中睾丸动脉保护、术后鞘膜积液的发生、精液质量的改善、复发率比较,差异均有统计学意义(P0.05)。结论除去手术时间长以外,从安全性及对精液质量的改善方面考虑,显微镜精索静脉结扎术优于腹腔镜精索静脉高位结扎术,值得临床推广。     

精索静脉曲张患者手术前后抗精子抗体的变化及意义

目的 探讨手术治疗精索静脉曲张(VC)对患者血清中抗精子抗体(ASAB)的影响.方法 分析60例左侧Ⅱ.VC患者.20例作为观察对照(A组);20例行保留睾丸动脉的精索静脉高位结扎术(B组);20例行不保留睾丸动脉的精索静脉高位结扎术(C组).酶联免疫法定量测定血清中抗精子抗体IgG、IgM含量.SPSS16.0软件进...     

双孔三通道腹腔镜下精索内静脉高位结扎术12例报告

目的 探讨双孔三通道腹腔镜下精索内静脉高位结扎术的可行性及疗效. 方法双孔三通道腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张患者12例.平均年龄28(19～37)岁.左侧7例,双侧5例.全麻,行脐孔内侧下缘弧形切口和脐与耻骨联合连线中点5 mm切口,采用4号丝线双重结扎精索血管柬. 结果12例手术均成功.单侧病变手术时间平均23(18～26)min,双侧病变手术时间平均33(30～34)min.术后平均住院2.7(2～3)d.随访3～6个月,未见明显手术瘢痕、睾丸萎缩及精索静脉曲张复发等并发症. 结论双孔三通道腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张微创、安全、美观、无需特殊设备、无新的学习曲线,具有一定推广价值.     

腹腔镜下精索内静脉高位结扎治疗精索静脉曲张20例报告

目的：探讨腹腔镜精索内静脉结扎治疗精索精脉曲张的临床价值。方法：腹腔镜下行保留精索动脉的精索内静脉高位结扎治疗精索静脉曲张20例。结果：全部获成功，手术时间平均45min，术后平均住院3天，随访3月--24月，平均7月，无复发，无睾丸萎缩。结论：该方法操作简便，创伤小，恢复快，安全可靠，是治疗精索静脉曲张的有效方法。     

精索静脉曲张手术方式的选择

目的 探讨在采用腹膜后精索静脉高位结扎术治疗精索静脉曲张的手术方法中，腹腔镜是否较开放手术更具优越性。方法 回顾性分析42例应用腹腔镜精索静脉高位结扎和53例应用开放手术经腹膜后精索静脉高位结扎术的病例。结果 两组病例在手术时间和术后住院时间上均无明显差异。术后恢复快，随访无复发和睾丸萎缩。结论 单侧精索静脉曲张，小切口腹膜后精索静脉高位结扎术仍值得首先推荐，对于双侧和复发的精索静脉曲张，则可以优先考虑腹腔镜手术。     

腹腔镜单纯高位精索内静脉结扎治疗小儿精索静脉曲张

目的 探讨腹腔镜治疗小儿精索静脉曲张的手术方法及其优越性。方法 经腹腔镜行精索内静脉高位结扎，术中保留精索动脉。结果 32例术后恢复顺利，无伤口感染、睾丸肿胀及发热。术后1天-3天出院。29例术后随访6月-12月，均无复发，无睾丸萎缩。结论 该方法具有操作简单，创作小，恢复快的优点，保留精索动脉，防止睾丸萎缩，是治疗小儿精索曲张行之有效的方法。     

Results and complications of laparoscopic surgery for pediatric varicocele

BACKGROUND: The aim of this study was to evaluate the results and complications of laparoscopic varicocelectomy in children. METHODS: Over a 36-month period, 211 children underwent laparoscopic treatment of varicocele. Their ages ranged between 6 and 17 years; the varicocele was located on the left side in 209 cases (99.1%) and was bilateral in 2 (0.9%). In 195 patients the laparoscopic transperitoneal approach was used and in 16 retroperitoneoscopy was used. Thirty children (14.2%) underwent ligation of the veins alone, and 181 (85.8%) underwent ligation of testicular veins and artery. In 15 (7.1%) cases an additional procedure was applied during the same operation. RESULTS: Average operating time was 30 minutes and hospitalization about 24 hours. At an average follow-up of 26 months, there were 19 (9%) postoperative complications: 14 children had a left hydrocele, 3 children a scrotal emphysema, and 2 an umbilical granuloma. There were 5 recurrences of varicocele in our series: 2 (2 of 30, 6.6%) after the Ivanissevitch procedure, and 3 (3 of 181, 1.6%) after Palomo's. Testicular atrophy did not occur in any patient of this series. CONCLUSIONS: This preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. The ligation of testicular veins and artery is preferable to the ligation of the testicular veins alone. Hydrocele seems to be the most frequent postoperative complication and a potential problem, especially in children operated on with the Palomo procedure.     

腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术的疗效比较

目的:对比观察腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术治疗精索静脉曲张的优点。方法:将36例腹腔镜下精索血管集束结扎术与38例腹腔镜下单纯精索内静脉结扎术的临床资料进行对比研究。结果:两组病例手术时间与术中出血量有明显差异(P<0.05);术后经12个月随访,两组间术后治愈率及复发率有明显差异(P<0.05)。结论:腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术相比,具有手术时间短、术中出血少、安全且治愈率高等优点。     

Laparoscopic treatment of pediatric varicocele: a multicenter study of the italian society of video surgery in infancy

PURPOSE: We report preliminary results of a multicenter study of the Italian Society of Video Surgery in Infancy on the laparoscopic treatment of pediatric varicocele. MATERIALS AND METHODS: A total of 161 children 6 to 16 years old (median age 12.5) underwent laparoscopic treatment of varicocele at 6 pediatric surgery divisions. Varicocele was on the left side in 159 cases (98.7%) and bilateral in 2 (1.3%). Two boys had recurrent left varicocele. All children were treated with laparoscopy, including ligation of the spermatic veins only in 28 (17.3%), and ligation of the testicular veins and artery in 133 (82.7%). In 10 boys (6.2%) an additional procedure was done simultaneously, including closure of an apparently patent peritoneal vaginal duct on the right side in 7 and resection of epiploic adhesions between the intestinal loops and abdominal wall from previous appendectomy in the remaining 3. RESULTS: Average operative time was 30 minutes and hospitalization was about 24 hours. At followup there were 13 minor complications (8%), including left hydrocele in 9 children who underwent the Palomo technique, minor scrotal emphysema in 2 and umbilical granuloma in 2. In our series varicocele recurred in 1 boy (3.5%) who underwent ligation of the spermatic veins only and in 3 (2.2%) treated with the Palomo technique. CONCLUSIONS: Our preliminary experience shows that the results of the laparoscopic approach are comparable to those of the open approach. However, the important advantages of laparoscopy over the open approach are its minimal invasiveness and precision of intervention. Moreover, laparoscopy allows treatment of other intra-abdominal pathological conditions using the same anesthesia, as in 10 patients in our series. We believe that ligating the testicular veins and artery is preferable to ligating the testicular veins only, even if the incidence of hydrocele is not negligible after the Palomo procedure.     

Laparoscopic occlusion of testicular veins for clinical varicocele.

Surgery via the laparoscope is now a reliable and cost-effective alternative to some open surgical procedures. Advances in videoendoscopy, incorporating optical magnification combined with the development of instruments with which to dissect, ligate, and transect blood vessels provide the urologist the opportunity to surgically correct a varicocele. In the outpatient setting, 4 patients (14-26 years of age) underwent laparoscopic ligation of the left internal spermatic veins for painful left varicocele. Carbon dioxide pneumoperitoneum was obtained using a Veress needle. A 10-mm laparoscope was placed intraperitoneally through a cannula inserted in the infraumbilical border. Utilizing two additional endosurgical ports (5 mm and 10 mm) through which 5-mm dissecting instruments and vaso-occlusive endoclips were placed, three veins were individually isolated and ligated in each of the 4 patients. In all 4 patients, the left testicular artery was visualized and preserved. There was no blood loss or other intraoperative complication. In each patient the varicocele was successfully corrected. Analgesic medication was not required postoperatively. We conclude that laparoscopic ligation of the internal spermatic veins is a safe and effective way of treating a varicocele without immediate postoperative sequelae. Long-term follow-up is necessary to determine the place of the endoscopic approach.     

腹腔镜精索血管集束状结扎与改良Palomo术治疗精索静脉曲张的疗效比较

目的探讨原发性精索静脉曲张不育患者作腹腔镜精索血管集束状结扎术与改良Palo—mo术的治疗效果。方法选择原发性精索静脉曲张不育患者80例，均有不同程度的生精功能障碍。病例随机分为两组，第一组42例，行腹腔镜下精索血管集束结扎术；第二组38例，行开放式腹膜后精索静脉高位结扎术。两组术前及术后3个月检查精液分析。将42例与38例开放式腹膜后精索静脉高位结扎术的临床资料进行对比研究。结果两组病例手术时间与术中出血量有明显差异（P〈0．05）；术后经12个月随访，两组间术后复发率有明显差异（P〈0．05）。两组精液质量较术前均有改善，而两组间精液精子数量、活动力、畸形率比较无显著性差异（P〉0．05）。结论腹腔镜精索血管集束状结扎术与开放式腹膜后精索静脉高位结扎术均可提高精液质量，但前者具有手术时间短、术中出血少、安全且治愈率高的优点。     

Optimizing the operative treatment of boys with varicocele: sequential comparison of 4 techniques

PURPOSE: We compared 4 techniques of varicocele ligation in boys and young adolescents to determine the optimal operative treatment that avoids varicocele recurrence and postoperative hydrocele formation. MATERIALS AND METHODS: In 10 years a total of 128 varicocelectomies were performed sequentially in 121 boys and young adolescents with a mean age of 12 years using the laparoscopic, inguinal testicular artery sparing, standard Palomo (high mass retroperitoneal ligation) and modified Palomo approaches. The modified Palomo approach involved suprainguinal and retroperitoneal ligation of the veins and artery, and microsurgical sparing of the blue stained lymphatic pathway of the testis. Patients were followed a mean of 52 months. RESULTS: In the 19 boys in the laparoscopy group varicocele persisted in 10% and hydrocele developed in 5%. In the 21 patients who underwent inguinal surgery with artery preservation recurrent varicoceles were identified in 14% and no hydroceles were observed. In the 32 patients who underwent the standard Palomo procedure there was no palpable varicocele persistence or recurrence, while hydroceles developed in 12%. Of the 56 patients in the modified Palomo group varicocele recurred in 1 (2%) and there were no hydroceles. No testicular atrophy developed in any patient. CONCLUSIONS: Comparison of all 4 groups revealed significant differences in varicocele recurrence (p = 0.038) and hydrocele formation (p = 0.023). Pairwise group comparison showed that the modified Palomo technique resulted in a significant decrease in the incidence of postoperative hydrocele formation compared with the standard Palomo method (p = 0.015). This procedure can be recommended as the optimal surgical technique for varicocele treatment in males of this young age.     

两孔法腹腔镜精索血管高位集束结扎术的临床研究（附218例报告）

目的探讨两孔法腹腔镜精索血管高位集束结扎术治疗精索静脉曲张的疗效与安全性。方法2003年3月～2008年3月间,218例精索静脉曲张患者施行了两孔法腹腔镜精索血管高位集束结扎术。回顾性分析病历资料,总结此术式优缺点。结果218例手术成功。手术时间平均35分钟,术后平均住院日3天。随访6～36个月,214例B超检查未见复发,4例复发：所有病例均未见术侧睾丸萎缩,未见肠粘连发生。结论两孔法腹腔镜精索血管高位集束结扎术治疗精索静脉曲张疗效确切、手术安全、操作简易、创伤少、恢复快,值得推广应用。     

The impact of internal spermatic artery ligation during laparoscopic varicocelectomy on recurrence rate and short post operative outcome

OBJECTIVE: To prospectively compare the recurrence rate and short postoperative outcome after randomized laparoscopic varix ligation with internal spermatic artery (ISA) preservation versus laparoscopic varix ligation with ISA ligation. MATERIAL AND METHODS: Twenty-five patients with 35 varicocele who required varix ligation for infertility in 13 patients, scrotal pain in 15 patients and scrotal swelling in 2 patients who underwent one of two procedures: laparoscopic varix ligation with ISA prservation (Group A) or laparoscopic varix ligation with ISA ligation (Group B) were postoperatively evaluated for short post operative outcome and underwent percutaneous spermatic venograms to detect recurrence. Fisher's Exact Test was used for statistical analysis. RESULTS: Recurrence through parallel collaterals was noted in 39% and 5.9% in Group A and Group B respectively as demonstrated on percutaneous spermatic venous venography (PSV) (statistically significant p = 0.0408). Preoperative pain completely resolved in all patients in Group B and persisted in 45% in Group A. However, this was not statistically significant (p = 0.088). No testicular atrophy or hydrocele formation was noted in either group. CONCLUSIONS: Laparoscopic varix ligation with ISA ligation has lower recurrence rate than laparoscopic varix ligation without ISA ligation and may provide better varicocele related pain control with no increase in hydrocele or testicular atrophy rate. We recommend ISA ligation routinely during laparoscopic varix ligation.     

Laparoscopic versus open high ligation of the testicular veins for the treatment of varicocele.

The purpose of this study is to determine the relative advantages of laparoscopic varicocelectomy compared to the conventional open high ligation of Palomo. We studied 193 patients who presented with varicocele. While 65 patients were treated by open high ligation of the testicular veins, 128 patients had laparoscopic varicocelectomy. In addition to varicocele ligation, 14 patients (11%) had laparoscopy-assisted right orchidopexy, and 5 patients (4%) had laparoscopic repair of concomitant right inguinal hernia. The mean hospital stay was 3.5 days and 1.3 days, respectively, and the recurrence rates were 10.8% and 3.9%, respectively. Return to normal activity was significantly earlier in Group II (mean 4.5 days) compared to Group I (mean 8.9 days). There was no incidence of testicular atrophy in any case in the study, regardless of whether the testicular artery was ligated or preserved during surgery. We conclude that laparoscopic varicocelectomy is safe, effective and minimally invasive. In addition to its better cosmetic results and advantage in case of bilateral disease, it allows excellent exposure and control of the affected vessels. Furthermore, the shorter hospital stay and the earlier return to normal activities are very important advantages in recommending this technique as an efficient alternative to the open surgical method.     

不同手术方式治疗精索静脉曲张的疗效比较

目的 比较高选择性精索静脉高位结扎术、经腹股沟管入路精索静脉结扎术和腹腔镜下改良Palomo术3种方法治疗精索静脉曲张的效果. 方法回顾性分析Ⅱ度以上原发性精索静脉曲张患者1075例,685例获随访.根据手术方式分3组:A组为高选择性精索静脉高位结扎术组,369例;B组为经腹股沟管人路精索静脉结扎术组.218例;C组为腹腔镜下改良Palomo术组,98例.对比观察3组术后阴囊水肿,睾丸、局部皮肤疼痛、麻木,睾丸萎缩,复发等远、近期并发症及精液改善和生育情况. 结果 A、B、C 3组复发率分别为3.3%(12/369)、7.3%(16/218)、5.1%(5/98),A、B组间比较差异有统计学意义(P<0.05);术后3个月睾丸萎缩发生率分别为0.5%(2/369)、17.9%(39/218)、9.2%(9/98),3组间比较差异有统计学意义(P<0.05);术后阴囊水肿发生率分别为1.4%(5/369)、17.4%(38/218)、16.3%(16/98),A组与B、C组间比较差异有统计学意义(P<0.05).A组≤30岁患者术后3～6个月精液质量提高率和术后1～2年配偶自然怀孕率高于其他2组≤30岁患者(P30岁者(P<0.05). 结论 高选择性精索静脉高位结扎术简单且术后阴囊水肿和睾丸萎缩发生率低,术后精液质量提高率和术后1～2年内配偶自然怀孕率高,值得临床推广.