Comparison of Laparoscopic and Microscopic Subinguinal Varicocelectomy in terms of Postoperative Scrotal Pain

Background and Objectives:

In this study, 2 different varicocelectomy methods were compared with regard to postoperative scrotal pain, length of operation, and complications.

Methods:

Forty varicocele patients, who visited our clinic because of infertility or scrotal pain between 2008 and 2009, were enrolled in this clinical study. Microscopic subinguinal varicocelectomy was performed on 20 patients in Group I, and laparoscopic varicocelectomy was performed on 20 patients in Group II. Following surgery, the patients were assessed for postoperative requirements for analgesia; return to normal activity; varicocele recurrence; hydrocele formation; scrotal pain at postoperative days 1, 3, and 7; and other complications.

Results:

Mean age was 24.2±3.4 years in Group I and 25.1±2.1 years in Group II. Mean pain scores at postoperative 1, 3, and 7 days in Group I were (5.20±1.14, 4.60±0.97, and 3.50±0.97, respectively) significantly higher than those of Group II (0.70±0.82, 0.60±0.84, and 0.10±0.32, respectively). Time to return to normal activity was significantly shorter in Group II (3.7±2.1 days) compared with Group I (6.8±3.4 days) (p=0.028). However, the number of recurrences and hydroceles, as a complication of varicocelectomy, was 2 times higher in Group II (10%) than in Group I (5%).

Conclusions:

We believe that laparoscopic varicocelectomy is a safe, effective, and minimally invasive procedure. Furthermore, reduced postoperative discomfort and earlier return to normal activity are additional advantages of this method.     

单孔与传统三孔法腹腔镜手术治疗双侧精索静脉曲张的对比研究

目的:探讨单孔与传统三孔法腹腔镜手术治疗双侧精索静脉曲张的临床价值。方法:回顾分析2009年10月至2011年6月26例单孔腹腔镜和30例传统三孔法腹腔镜双侧精索静脉高位结扎术的临床资料。结果:两组术后住院时间、住院总费用、手术安全性、术后并发症等无明显差异,三孔组手术时间、操作难度优于单孔组,但单孔腹腔镜术后切口瘢痕小,更能体现微创、美容的效果。结论:单孔腹腔镜手术具有微创手术的所有优点,术后腹壁不留瘢痕,创伤更小,是微创治疗精索静脉曲张的新进展,值得推广应用,但手术时间较长,有一定的操作难度。     

经脐周三孔法腹腔镜下精索静脉高位结扎术的临床应用

目的探讨经脐周三孔法腹腔镜下精索静脉高位结扎术的临床应用价值。方法回顾性分析本院采用经脐周三孔法腹腔镜下治疗精索静脉曲张38例的临床资料,其中左侧21例,双侧17例。结果 38例手术均获得成功,无严重并发症发生,无1例中转改开放术,手术时间(20±8.2)min。38例术后随访3个月至1年,无复发。结论经脐周三孔法腹腔镜下精索静脉高位结扎术与普通三孔法无明显差异且具有"无切口"美观效果。     

CEUS诊断精索静脉曲张侧支反流

目的 探讨CEUS诊断精索静脉曲张(VC)侧支反流的临床意义.方法 对60例单纯左侧VC患者行精索静脉CEUS,观察是否存在开放侧支血管,并用Doppler检测反流情况.根据造影结果将60例VC患者分为无侧支组(A组)和有侧支组(B组).造影完成后对全部患者行精索内静脉高位结扎术,并于术前及术后6个月检查精液质量、睾丸大小、术后复发及配偶受孕情况,以评价治疗效果.结果 A组41例(41/60,68.33％),B组19例(19/60,31.67％).B组27支侧支血管开放,其中13例18支侧支血管检测出反流频谱.术后6个月复查,两组患者的左侧睾丸体积较术前均有所增大(P＞0.05);与术前比较,术后A组精液质量较B组有明显改善(P＜0.05);术后A组无复发病例,B组5例复发;A组7例、B组2例的配偶受孕成功.结论 精索内静脉高位结扎术对无开放侧支血管VC的治疗效果好于有开放侧支血管者.侧支反流是术后VC复发的主要原因.CEUS可于术前诊断阴囊段及腹股沟段VC合并侧支反流,为外科选择治疗方案提供依据.     

精索静脉曲张不育症的内分泌变化

受试者有正常对照(12人),以及精索静脉曲张不育症精子减少(20人)和精子无力(12人)三组,分别用放免法测定血清积精液中的睾酮、双氢睾酮、促黄体生成素及促滤泡成熟激素。结果雄激素稍有降低,促黄体生成素和促滤泡成熟激素均有增高,尤以后者变化显著。本文对精索静脉曲张不育症的内分泌变化,精索静脉曲张引起的睾丸病变和功能损害,以及精索内静脉高位结扎治疗精子减少有较明显效果等问题进行讨论。     

同轴插管经皮远端硬化栓塞治疗精索静脉曲张

为了减少精索静脉曲张经皮硬化栓塞术中的复发因素，提高硬化剂治疗的效果，从１９９１年３月至１９９５年６月使用同轴插管方法，进行精索静脉远端主干和近端侧支血管的硬化栓塞，共治疗左侧精索静脉曲张２３例，精索静脉近端插管全部成功，远端插管的成功率为７８．０％，栓塞后的显效率为９５．６％，无并发症。平均随访１４个月未见复发。认为该方法可准确、安全、高效地进行精索静脉曲张的硬化治疗。     

Left spermatic vein in left-sided vena cava

The left spermatic vein was found to drain directly into a left-sided vena cava in a patient with left varicocele. The implications for embolization of this anomaly are obvious.     

精索静脉曲张大鼠睾丸ABP、核雄激素受体和血清睾酮含量的变化

本实验在人工诱导大鼠精索静脉曲张病理模型的基础上,对睾丸雄激素结合蛋白(ABP)、核雄激素受体(NAR)以及精索静脉血清睾酮水平进行了观察。结果表明,精索静脉曲张组(VG)左、右两侧睾丸细胞核雄激素受体含量均高于假手术对照组(SOG)(P<0.01,P<0.05);睾丸ABP浓度VG与SOG双侧相比无明显差异(P>0.05);精索静脉血清睾酮水平VG左右两侧均显著低于SOG(P<0.001)。研究结果提示,精索静脉曲张睾丸功能障碍可能与血清睾酮浓度低下及睾丸细胞核雄激素受体反应异常有关。     

高位腹膜后径路手术治疗精索静脉曲张34例报告

目的 :探讨高位腹膜后径路 (改良Palomo术 )治疗精索静脉曲张的疗效。方法 :采用腹膜后高位结扎精索静脉 (改良Palo mo术 ) ,治疗患者Ⅱ°以上原发性精索静脉曲张 34例。结果 :34例患者中 2 5例症状明显或 (和 )体检发现Ⅱ°以上原发性精索静脉曲张者 ,术后 3个月复诊 ,2 3例症状、体征改善 ,2例无明显改善 ;9例因精索静脉曲张继发不育病人 ,术后精子数目、活力明显改善 6例 ,3例无改善。对于手术有效病人 2 9例 ,再进行半年以上随访 ,随访 2 6例 ,失访 3例 ,平均随访 6～ 18个月 ,未见复发 ,未见睾丸、附睾萎缩。结论 :该术式操作简便 ,副损伤小 ,疗效好 ,不易复发 ,值得提倡。     

腹腔镜精索内静脉结扎术11例报告

应用腹腔镜技术为11例患者行精索曲张静脉高位结扎术。硬膜外麻醉,手术均获成功,无一例发生并发症,手术时间20～70min,术后当天下床活动,次日出院。对该手术方法的优缺点和适应证进行了讨论。