腹腔镜改良Palomo术治疗精索静脉曲张20例

2002年5月以来，我们对20例精索静脉曲张患者行腹腔镜改良Palomo术，疗效满意。现报告如下。     

小切口Palomo术治疗单侧精索静脉曲张6例报告

本文报道小切口Palomo术治疗单侧精索静脉曲张6例,取第一腹横纹与腹股沟韧带中点上方3 cm处的交点向内侧做长1.5～2.5 cm腹横纹切口,游离出曲张的精索静脉1～3支,靠近头端予以切断结扎,远端结扎前先挤压阴囊排出淤血.手术均获成功,手术时间15～25 min.患者术后第1天即可下床活动,术后住院2～3天,随访3～5个月无复发.作者认为成功的关键在于切口位置的选择,精索静脉曲张可选择小切口Palomo术.     

改良Palomo术治疗精索静脉曲张21例报告

我院自 1986年 1月～ 2 0 0 1年 6月 ,采用改良Ｐａｌｏｍｏ术(腹膜后精索内静脉高位结扎术 )治疗精索静脉曲张 2 1例。年龄 13～ 4 0岁 ,平均 2 6 .2岁。其中 ,左侧 2 0例 ,右侧 1例。临床分期 :Ⅱ度 14例 ,Ⅲ度 7例。结　果　 2 1例精索静脉曲张患者 ,经改良的Ｐａｌｏｍｏ手     

腹腔镜精索内静脉高位结扎治疗精索静脉曲张

<正> 我院自1996年1月至1997年4月行腹腔镜精索内静脉高位结扎治疗精索静脉曲张15例,术后随访3个月以上,效果满意,报告如下。 1 资料与方法 1.1 一般资料 本组15例,年龄19～35岁,平均23岁,均为左侧精索静脉曲张,其中Ⅱ度6例,Ⅲ度9例,均有不同程度的阴囊坠、胀痛等临床症状,不育者4例,其精液常规检查以少精和精子活动不良为主要表现。其中3例为经腹股沟精     

Palomo手术治疗精索静脉曲张

我院自1995年10月至2002年8月共采用Palomo手术治疗精索静脉曲张66例，效果满意。报告如下。     

经脐Mini纯单孔腹腔镜下Palomo术治疗78例青少年精索静脉曲张

目的 探讨经脐Mini纯单孔腹腔镜术治疗原发性青少年精索静脉曲张的优越性.方法 对78例原发性青少年精索静脉曲张患者均行经脐Mini纯单孔腹腔镜下Palomo手术治疗,观察疗效,总结手术时间、出血量、并发症及住院时间.所有患者术后随访6 ～18个月.结果 78例手术均获成功,疗效满意,手术时间5 ～ 15 min,平均8 min,术中出血量1～5 mL,平均1.5 mL,术后住院时间2～4d,平均3d.术中、术后无并发症.随访6～18个月复查精液常规95％正常.结论 经脐Mini纯单孔腹腔镜下Palomo术治疗原发性青少年精索静脉曲张有明显优越性,具有推广应用价值.     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张

目的:探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的临床价值。方法:回顾分析腹腔镜精索静脉高位结扎术治疗精索静脉曲张19例患者的临床资料,并评价手术方法的优缺点。结果:19例患者手术均获成功,手术时间20~80m in,基本无出血,术毕拔除导尿管,术后1~4d出院,平均住院2.5d。结论:腹腔镜精索静脉高位结扎术可避免开腹手术的较大损伤和对输精管的误伤,而且双侧可同时手术治疗;尽管费用稍高,仍不失为一种较好的治疗手段。     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张

目的 探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的临床价值.方法 应用腹腔镜技术为63例患者施行双侧精索静脉高位结扎术.结果 63例患者手术均获成功,手术时间(33±9) min,基本无出血,术后2～3 d出院,平均住院2.3 d,随访6个月,曲张静脉均消失,伴男性不育症者精液质量明显改善.结论 腹腔镜精索静脉结扎术效果可靠、对机体干扰轻、并发症少、康复快、复发率低,且可同时施行双侧手术,值得临床推广应用.     

对比Palomo手术与腹膜后精索内静脉高位结扎术治疗精索静脉曲张

目的对比经腹膜后集束结扎精索血管（Palomo手术）与腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的疗效及并发症。方法对2000年7月-2006年6月间，25例采用Palomo术式，30例采用腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的临床资料进行对比分析。结果所有手术均获得成功，术后随访6月至2年。Palomo手术组手术时间12～18min，手术后3—10d曲张静脉团显著缩小，所有患者临床症状消失。随访18例，无复发，无睾丸坏死或萎缩发生，6个月内发生左侧睾丸鞘膜积液3例，占16．6％，左侧慢性附睾炎1例，左侧睾丸疼痛（排除其它原因）1例。单纯精索内静脉高位结扎组手术时间20-35min，1例术后无效，29例术后1—8d曲张静脉团消失。3例术后2—4月后复发，占15％。精索内静脉高位结扎组术后复发率显著高于Palomo手术组（P〈O．05），而后者术后并发症明显高于前者，两者有显著的统计学差异（P〈0．05），主要并发症是患侧的睾丸鞘膜积液。后者手术时间明显较短（P〈0．01）。两组手术均效果良好，疗效可靠。结论Palomo手术简单易行、疗效可靠，但并发症较多；腹膜后精索内静脉高位结扎复发率高，但无并发症发生。     

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。     

改良Palomo术治疗精索静脉曲张的疗效分析

目的：探讨精索静脉曲张（Vc）患者行改良Palomo术的疗效,分享手术经验。方法：2009年7月～2012年1月采用改良Palomo术治疗伴有精液质量下降的VC患者182例,观察手术治疗后精液参数的变化及配偶自然受孕情况。结果：182例手术均获得成功。手术前后精液质量经统计学分析,差异有统计学意义（PdO．01）,术后精液质量明显改善;不育患者配偶自然受孕率为54．55％（84／154）,均未出现阴囊水肿及睾丸萎缩,均未复发。结论：改良Palomo术对伴有精液质量下降的VC患者效果良好,且对不育也有很好的疗效。     

Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality

Efficacy of surgical varicocelectomy versus embolization of the spermatic vein was studied in 137 men diagnosed as suffering from left varicocele. The men were divided randomly into three groups according to the methods of treatment: A--embolization of the internal spermatic vein (51 men); B--Ivanissevich technique of high ligation of the spermatic veins (43 men); and C--Bernardi technique of high ligation (43 men). The groups were similar in terms of age, duration of infertility and possessed semen characterized as oligoteratoasthenozoospermia. The fertility of the female partners was evaluated carefully and they were found to be potentially fertile. Varicocele was diagnosed by at least two of the following methods: physical palpation during valsalva manoeuvre, venography, or scrotal scanning using the technetium pertechnetate radioactive method. Semen quality was assessed before treatment and at 3, 6 and 9 months post-treatment. Fecundity was followed-up for 18 months. The major results were: (i) Shrinkage of the varicocele was found in all three groups studied. The same rate of recurrence was recorded in the three groups (24%, 37% and 35% in groups A, B and C, respectively). (ii) Improvement of sperm quality was significant in groups A and B, with better results in group B. (iii) The pregnancy rate was significantly higher in group B, compared with A (38.2% vs. 20.6%; P less than 0.05). Thus, high ligation of the internal spermatic vein yields better results than low ligation or embolization as far as semen quality and pregnancy is concerned.     

Comparison of spermatic vein histology in patients with and without varicocele

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.     

双孔三通道与传统腹腔镜下精索静脉高位结扎术对比研究

目的:观察双孔三通道与传统腹腔镜精索静脉高位结扎术疗效,探讨双孔三通道精索静脉高位结扎术临床应用价值。方法:2011年1月至2013年3月我院78例(89侧)精索静脉曲张患者,随机分成两组。改良组38例,行双孔三通道腹腔镜精索静脉高位结扎术;传统组40例,行传统腹腔镜精索静脉高位结扎术。对两组患者安全性和临床疗效对比分析。术后3个月观察两种术式切口瘢痕,进行满意度评分。结果:38例患者行双孔三通道腹腔镜精索静脉高位结扎术均顺利完成。手术时间[单侧:(21.3±1.5)min;双侧:(32.5±2.3)min],术中、术后并发症,住院时间[(3.2±0.3)d vs(3.7±0.7)d]与恢复时间(1天下床率87%vs 78%),症状缓解[阴囊疼痛缓解率(73%vs 58%]与精子浓度[(26.25±10.22)×106/ml vs(29.13±11.41)×106/ml]、活动率[(52.36±9.82)%vs(55.26±11.34)%],与传统腹腔镜组比较无显著性差异(P0.05)。观察术后3个月切口瘢痕改良组明显优于传统组。改良组患者对瘢痕满意度综合评分[(2.69±0.32)分],与传统腹腔镜组[(1.27±0.21)分]比较差异有显著性(P0.05)。结论:双孔三通道腹腔镜精索静脉高位结扎术安全、微创、美观、经济、简便,是可选手术中较为理想的术式,值得临床推广。     

Retroperitoneal high ligation versus subinguinal varicocelectomy: Effectiveness of two different varicocelectomy techniques on the treatment of painful varicocele

In the present study, we compared the retroperitoneal high ligation with subinguinal varicocelectomy on the treatment of painful varicocele. A total of 90 patients who underwent retroperitoneal high ligation (n = 45) and subinguinal varicocelectomy (n = 45) for painful varicocele were included in this prospective study. Varicocele in all patients was diagnosed with by physical examination and coloured Doppler ultrasonography. All the patients underwent a conservative treatment for pain for 4 weeks. Patient ages, varicocele grades, preoperative pain scores, postoperative pain scores at 6 months, duration of surgeries, complications and recurrences were recorded. Complete success rate for chronic scrotal pain was found to be 80% in retroperitoneal varicocelectomy group and 71% in subinguinal varicocelectomy group. Partial success rate was 11% for retroperitoneal varicocelectomy group and 18% for subinguinal ligation group. There was no significant difference between two groups in terms of pain and complications. However, the operation time was significantly lower in the Palomo group. Although microsurgical subinguinal varicocelectomy is the current approach for the treatment of varicocele, retroperitoneal high ligation can achieve the same pain resolution with shorter operative duration compared to loupe‐assisted subinguinal varicocelectomy.     

腹腔镜术与常规手术治疗精索静脉曲张不育症351例疗效观察

本文对３５１例精索静脉曲张不育症患者采用腹腔镜精索静脉结扎术（２４４例,其中１３例连同精索内动脉一并结扎）和经腹股沟精索静脉结扎术（常规手术,１０７例）,术后随访３～３２个月。在术后８周,两组精子计数、活动率、活动力均较术前有显著改善（Ｐ〈０．０１）。腹腔镜组精索内动脉结扎与否,其精子改善情况无显著差异（Ｐ〉０．０５）。两组相较,腹腔镜组术后精子计数、活动力的改善更为显著（Ｐ〈０．０１）。在术后１４周时,常规手术组精子计数仍明显低于腹腔镜组（Ｐ〈０．０５）。随访期间腹腔镜组妊娠者１４９例,妊娠率６１．０７％（其中动脉结扎者７例,妊娠率５３．８５％）,常规手术组妊娠者６２例,妊娠率５８．９３％,两组妊娠率无明显差异（Ｐ〉０．０５）。     

Comparative hemodynamic evaluations of varicocele by bidirectional ultrasonic Doppler sonography and phlebography of the internal spermatic vein

Clinical studies (degree of severity) and bidirectional ultrasonic Doppler sonography (Pressure-type, Shunt-type) of varicocele were compared with the phlebography of the internal spermatic vein (degree of spermatic incompetence, diameter of the int. spermatic v.). Doppler probe and phlebography are equivalent methods to demonstrate the venous reflux in palpable varicocele and for follow-up examination after sclerotherapy. The subclinical varicocele is discussed. The slight degree of spermatic incompetence (reflux by Valsalva's manoeuvre) is responsible for the small varicocele (grade I) and the Pressure-type. The severe degree of spermatic incompetence (spontaneous reflux) causes the Shunt-type and the large varicocele (grade III) as well as a dilatation of the internal spermatic vein.     

腹腔镜保留睾丸动脉精索静脉高位结扎术对睾丸生精功能的影响

目的 探讨腹腔镜下精索内静脉高位结扎同时保留睾丸动脉治疗精索静脉曲张的应用价值.方法 选取156例精索静脉曲张患者,随机分成A、B两组:A组采用腹腔镜下保留睾丸动脉精索静脉高位结扎术,B组采用传统的Palomo术式.比较两组手术前后精液质量参数变化、术后并发症的发生率.结果 A组的手术时间为(32.24士8.35)min,明显短于B组(36.45士9.14)min (P＜0.05),术后阴囊水肿(2.67％)、附睾炎(4％)、睾丸萎缩率(2.67％)明显低于B组(P＜0.05),住院时间、术后复发率比较无统计学意义(P＞0.05);术后精子计数[(43.00±4.3)×106]、精子活率[(65.00±4.55)％]明显高于B组[(37.20士5.45)×106]、[(53.34±6.73)％](P＜0.05),精子密度、精子活力分级比较差异无显著性(P＞0.05).结论 保留睾丸动脉腹腔镜精索内静脉高位结扎术能够明显提高术后精液参数质量,降低阴囊水肿、附睾炎、睾丸萎缩的发生率.     

精索静脉曲张不育患者精囊内静脉血中活性氧和抗氧化剂的关系(英文)

目的:以外周静脉血作为比较对象,评估精囊内静脉血中活性氧(ROS)和抗氧化剂的关系。方法:观察对象为68名患有精索静脉曲张的少弱精患者。在腹股沟的曲张精索静脉切除术中,提取精囊内血液样本和中央尺骨静脉血样本。分别测定这些血液样本中的三种 ROS(丙二醛[MDA]、双氧水[H_2O_2]、一氧化氮[NO])和四种抗氧化剂(过氧化岐化酶[SOD]、过氧化氢酶[Cat]、谷胱甘肽过氧化酶[GPx]、维生素 C)。结果:精囊内静脉血样内的 ROS 因素的平均值明显高于外周血中的值(MDA 18.7±1.4 nm/mL vs.15.4±1.4 nm/mL,H_2O_2 43.6±8.0 Um/mL vs.30.8±8.1 Um/mL,NO 2.3±0.5 nm/L vs.1.6±0.4nm/L,P<0.01)。而精囊内静脉血的抗氧化剂的平均值明显低于外周血中的值(SOD 1690.7±130.0 U/mL vs.1818.5±143.0 U/mL,Cat 38.9±6.1 mm/mL vs.47.9±10.2 mm/mL,GPx 20.4±8.1 U/mL vs.23.0±8.4 U/mL,维生素 C 0.3±0.1 vs.0.4±0.1 mg/dL,P<0.05)。结论:患有精索静脉曲张不育男性的精囊内静脉血相对于外周静脉循环,具有更高的 ROS 和更低的抗氧化剂。     

Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele

Aim:To evaluate the treatment outcome of antegrade internal spermatic vein sclerotherapy in men with non-obstruc-tive azoospermia or severe oligoteratoasthenospermia(OTA)as a result of varicocele.Methods:Between September1995 and January 2004,47 patients(mean age 33.8±6.3 years)underwent antegrade internal spermatic vein sclero-therapy for the treatment of varicocele with azoospermia(14 patients)or severe OTA(33 patients).Testicular corebiopsy was also performed in complete azoospermic patients who provided informed consent.The outcome wasassessed in terms of improvement in semen parameters and conception rate.Results:Forty-two(89.4%)of 47patients had bilateral varicocele,Serum follicle stimulating hormone(FSH)did not differ between patients withazoospermia and severe OTA.After the follow-up of 24.8±9.2 months,significant improvement was noted in meansperm concentration,motility and morphology in 35 patients(74.5%).Comparison between groups during thefollow-up revealed significantly higher values of sperm concentration,motility and normal morphology in the severeOTA group.Pregnancy was achieved in 14 cases(29.8%).Testicular histopathology of the azoospermic patientswith postoperative induction of spermatogenesis revealed maturation arrest at spermatid stage,Sertoli-cell-only(SCO)with focal spermatogenesis or hypospermatogenesis.None of the patients with pure SCO pattern or maturation arrestat spermatocyte stage achieved spermatogenesis after the treatment.Preoperative serum FSH levels didn't relate totreatment outcome.Conclusion:Antegrade internal spermatic vein sclerotherapy is an easy and effective treatmentfor symptomatic varicocele.It can significantly reverse testicular dysfunction and improve spermatogenesis in menwith severe OTA,as well as induce sperm production in men with azoospermia,improving pregnancy rates insubfertile couples.(Asian J Androl 2006 Sep;8:613-619)