免气腹悬吊式单孔腹腔镜集束结扎手术治疗精索静脉曲张

目的 探讨悬吊式免气腹单孔腹腔镜经腹膜后集束结扎精索血管（Palomo手术）治疗精索静脉曲张的临床疗效及应用经验.方法 自2012年3月至2013年2月,惠州市第三人民医院的40例左侧精索静脉曲张的患者被随机分为A、B两组,每组20例,分别应用悬吊式免气腹单孔腹腔镜Palomo手术治疗（A组）及传统腹腔镜精索血管集束结扎术治疗（B组）,分析比较两组的临床资料,评估手术的疗效及并发症.结果 两组共40例手术均获成功.A、B组手术平均时间分别为（25±4） min和（24±3） min,术中平均出血量分别为（6±2） ml和（6±2） ml,术后平均住院时间分别为（3±1）d和（3±1）d.手术总费用分别为（5947±212）元和（9157±285）元.术后随访至6个月,两组均无手术并发症出现.两组比较采用的独立样本t检验,手术时间、术中出血量、术后住院天数差异均无统计学意义（P＞0.05）,手术总费用有明显差异,免气腹单孔腹腔镜组费用明显低于标准腹腔镜组（P＜0.05）.结论 悬吊式免气腹单孔腹腔镜Palomo手术治疗精索静脉曲张具有操作简单、创伤小、康复快、并发症少、费用低的优点,手术治疗效果满意,有推广应用价值.

Application of gasless single port laparoscopic Palomo operation in treatment of varicocele

Objective To investigate the clinical effects of gasless single port laparoscopic Palomo operation in treatment of varicocele and summarize the experiences.Methods From March 2012 to February 2013,40 patients with varicocele were randomly divided into two groups.Group A underwent gasless single port laparoscopic Palomo operation （20 cases）,and group B underwent conventional laparoscopic Palomo operation （20 cases） in the Third People＇s Hospital of Huizhou.The data of theses cases were analyzed to evaluate the efficacy and complications.Results The operations of 40 cases were accomplished.The operation time was 18 to 35 min,mean time （25±4） min in group A,and 19 to 32 min,mean time （24±3） min in group B.The blood loss was 5 to 10ml mean blood loss （6±2） ml in group A,and 3 to 10 ml mean blood loss （6±2） ml in group B.Hospital stay duration was 3 to 4 d,mean （3±1） d in group A and 3 to 4 d,mean （3±1） d in group B.The total cost was 5700-6380 Yuan,mean （5947±212） Yuan in group A,and 8765-9731 Yuan,mean （9157±285） Yuan in group B.The patients were followed up to 6 months.No complications occurred in these cases.There were no significant difference in the operation time,blood loss,postoperative hospital stay between the two groups （P〈0.05）.However,there was obvious difference in the total cost of operation between the two groups.The cost of gasless single port laparoscopic group was significantly lower than the cost of conventional laparoscopic group.Conclusion Gasless single port palomo operation has the advantages of easily manipulated,minimal invasive,rapid recovery,few complications and less cost.It can provide satisfactory clinical efficacy for the treatment ofvaricocele and it has a great value.