三种术式治疗精索静脉曲张的临床疗效比较

目的 探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和传统开放手术(经腹股沟管精索静脉结扎术)治疗精索静脉曲张的临床疗效及差别.方法 将135例精索静脉曲张手术患者按照随机数字表法分为三组,腹腔镜下精索静脉高位结扎术组(A组,50例)、改良Palomo术组(B组,70例)和传统开放手术组(C组,15例),对三组患者的手术时间、住院时间、手术费用,术前、术后1、6、12个月的精液质量进行比较,并追踪18个月内患者精索静脉曲张复发、配偶临床妊娠结果 及睾丸萎缩的发生情况.结果 三组患者在单侧手术时间、住院时间方面比较差异无统计学意义(P>0.05);住院费用方面A组明显高于B、C组(P<0.05),而B、C组间比较差异无统计学意义(P>0.05);三组术后精液质量均较术前有显著提高(P<0.05),但组内术后1、6、12个月精液质量各参数比较差异无统计学意义(P>0.05).术后随访18个月,C组复发率13.3%(2/15),显著高于A组的0和B组的1.4%(1/70)(P<0.05),三组配偶临床妊娠率比较差异无统计学意义(P>0.05)[A组68.0%(34/50),B组68.6%(48/70),C组66.7%(10/15)].随访期间三组均无睾丸萎缩.结论 腹腔镜下精索静脉高位结扎术和改良Palomo术是治疗精索静脉曲张的安全、简单、有效的手术方式.对于单侧精索静脉曲张,改良Palomo术值得首先推荐;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.

Abstract：

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.

Clinical therapeutic effectiveness analysis on three surgical methods of the varicocele patients

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.