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。     

一孔法微型腹腔镜精索静脉高位结扎术

目的介绍一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张的手术方法,探讨其临床应用价值。方法采用一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张11例,年龄19～45岁,平均26岁,病程1个月至5年,单侧病变9例,双侧病变2例。结果单侧精索静脉曲张手术时间为10～20min,平均12min,双侧病变患者手术时间为1例20min,1例30min,平均25min。患者术后疼痛轻微、均无需使用止痛药,平均住院时间2．7d,随访1-3个月未见复发、阴囊气肿、阴囊水肿、鞘膜积液、睾丸萎缩等并发症。结论一孔法微型腹腔镜精索高位结扎术治疗精索静脉曲张疗效可靠,具有微创、安全、美观的优点。     

The application of microanastomoses in the surgical treatment of varicocele]

We operated on 50 patients with varicocele employing microsurgical anastomosis. Clinical results were satisfactory with varicocele disappearing 49 times out of 34 cases. The shunt between a high regimen pressure with a lower one improve the venous drainage of the testis. These new techniques must be selected according to the pathogenic mechanism of varicocele.     

Effects of surgical repair of first degree varicocele on gonadal function and testicular atrophy

Varicocele is one of the main causes of male infertility. This pathology, in fact, is responsible for progressive anatomical and functional testicular damage. Constant monitoring of subjects suffering from varicocele is therefore necessary. In the present study, we evaluated the effect of varicocele surgical treatment on seminal parameters, testicular growth and pregnancy rate in patients with grade I varicocele. We operated on 47 patients with left grade I varicocele associated with sperm abnormalities and with testicular hypotrophy. A high ligation of the internal spermatic vein and all its collaterals was performed in all patients. The postoperative follow-up showed a significant improvement in seminal parameters (motility, morphology and sperm count) and in testicular volumes. Moreover, a pregnancy rate of 58% was observed. These results confirm the observations of other investigators and suggest that surgical therapy of varicocele is capable of improving seminal parameters, of reversing varicocele-related testicular hypotrophy and of achieving high pregnancy rates even in patients with grade I varicocele.     

腹腔镜下精索静脉高位结扎术治疗精索静脉曲张(附32例报告)

目的:评价腹腔镜下精索静脉高位结扎术的有效性、安全性及其价值。方法:回顾分析32例腹腔镜下精索静脉高位结扎术的疗效和康复情况。结果:32例手术均获成功,平均手术时间34m in,基本无出血,术后平均住院2.8d,随访3~10个月,2例复发,复发率为6.25%。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,对双侧精索静脉曲张及预防术后复发更具价值。     

X-ray endovascular research in varicocele in children]

60 patients with varicocele first diagnosed and 38 with postoperative recurrences of varicocele were examined with use of digitalis subtraction renal and testicular phlebography as an optional diagnostic method. In the patients' group with varicocele recurrences the roentgeno-endovascular method allowed the causes of relapses associated with inadequate ligation of testicular vein influxes to be revealed (73.3%) and collateralization of the operated region (26.3%). In patients with firstly diagnosed varicocele the phlebography confirmed the diagnosis in 98.3%; revealed associated urogenital diseases; allowed indications for a specific mode of surgical correction to be formulated. 78 patients underwent testicular vein roentgeno-endovascular occlusion with 3% solution of thrombovar, 15 were operated on by the method of Ivanissevich in whom a level and character of surgical ligation were defined by phlebographic data; one patient had the operation testicular-saphenous anastomosis; one patient was not operated due to his systemic blood disease. By digitalis subtraction angiographic data recurrence rates after a proper treatment were 2%. 4.1% had thrombophlebitis of the racemose plexus after a sclerotherapy conservatively abolished. The use of digitalis subtraction testicular phlebography allowed one to properly choose a surgery and to decrease relapse rates due to its high preoperative diagnostic efficacy. In addition, preoperative X-ray endovascular examination made it possible to reveal the cause of relapses after early performed operations, to detect synchronous renal lesions in time, and to prevent recurrences by reducing the amount of a contrast medium by a factor of 2-3.     

微型腹腔镜一孔法治疗精索静脉曲张

目的介绍一孔法微型腹腔镜精索静脉结扎术治疗精索静脉曲张的手术方法,探讨其临床应用价值。方法采用一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张20例,单侧病变17例,双侧病变3例。结果单侧精索静脉曲张手术时间平均为12（10～20）min,双侧病变患者手术时间约为23（20～30）min。患者术后疼痛轻微、均无需镇痛,平均住院时间2.6（2～4）d。均获随访,时间1～9个月,未见复发、阴囊气肿、阴囊水肿、鞘膜积液、睾丸萎缩等并发症。结论一孔法微型腹腔镜精索高位结扎术治疗精索静脉曲张疗效可靠,更具有微创、安全、美观的优点。     

Treatment of varicocele using a microsurgical technic

We operated on 34 patients with varicocele employing microsurgical anastomosis. A direct anastomosis of veins of varicocele with the saphenous vein was performed in 29 patients. Microsurgical spermaticoepigastric anastomosis was performed in 5 patients. The distal stump of the epigastric vein was end-to-end anastomosed with the spermatic vein in one case of type 2 varicocele. Clinical results were satisfactory with varicocele disappearing 33 times out of 34 cases. The shunt between a high regimen pressure with a lower one improve the venous drainage of the testis. These new techniques must be selected according to the pathogenic mechanism of varicocele.     

Minimal invasiveness and effectivity of subinguinal microscopic varicocelectomy: a comparative study with retroperitoneal high and laparoscopic approaches

AIM: The standard management of varicocele repair is the subject of ongoing controversy. We retrospectively evaluated three surgical methods of varicocele treatment to determine the minimally invasive and most effective procedure. METHODS: We performed 144 varicocelectomies on infertile patients with left clinical varicocele. Of the patients, 50 were treated with retroperitoneal high ligation under lumbar anesthesia, 33 with laparoscopic ligation under general anesthesia, and 61 with subinguinal microscopic ligation under local anesthesia. Operative time, hospital days, and clinical outcomes were compared between these techniques. RESULTS: The operating time and hospitalization period required for subinguinal microscopic ligation was signi fi cantly shorter compared to those for the other procedures. All patients treated with subinguinal microscopic ligation could achieve normal activity as soon as they returned to their rooms. Postoperative complications were observed in fi ve (10.0%) cases treated with high ligation and three (9.1%) laparoscopic cases, but were not observed after the subinguinal procedure. There were six cases (12.0%) of recurrence in the high ligation group and six (6.1%) in the laparoscopic group, but none in the subinguinal group. Sperm density was signi fi cantly improved in all procedures postoperatively, but sperm motility was not improved. The two-year pregnancy rate calculated by the Kaplan-Meier method was 35.8% for high ligation, 40.4% for laparoscopic ligation and 50.9% for subinguinal microscopic ligation, although there were no statistical differences between the three groups. CONCLUSION: We concluded that subinguinal microscopic varicocelectomy could be a minimally invasive procedure compared to the other two techniques and a worthy method for treating male infertility due to clinical varicocele.     

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。     

前腹腔镜精索静脉高位结扎术

目的探讨前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。方法回顾分析前腹腔镜精索静脉高位结扎术治疗精索静脉曲张31例患者的临床资料。结果31例手术均获得成功,平均手术时间为43.5 min,术后平均住院3 d,术后随访3~12个月,所有病人临床症状均消失,无复发。术前伴精液常规异常的6例,有5例明显改善,1例无变化。结论前腹腔镜精索静脉高位结扎术损伤小,不干扰腹腔,操作简单,并发症少,术后恢复快,值得推广应用。     

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。     

显微精索静脉结扎手术联合少腹逐瘀汤治疗精索静脉曲张致少弱精子症

目的探讨保留动脉的显微精索静脉结扎术联合少腹逐瘀汤治疗精索静脉曲张(VC)致少弱精子症的临床疗效。方法选取50例精索静脉曲张性不育患者,随机分成观察组和对照组各25例,治疗组给予显微精索静脉结扎手术联合少腹逐瘀汤,日服一剂,分早晚服,连续服用3个月;对照组只行显微精索静脉结扎手术。结果两组患者均手术成功,术后症状消失,精子浓度、精液量、精子活力明显提高,畸形精子百分率明显降低,较手术前比较,差异有统计学意义(P<0.05)。而观察组3个月后患者各项精液参数改善显著,明显优于对照组(P<0.05)。结论显微精索静脉结扎手术联合少腹逐瘀汤治疗精索静脉曲张所致少弱精子症疗效满意,精液质量改善明显。     

腹腔镜治疗精索静脉曲张235例

目的探讨腹腔镜治疗精索静脉曲张的疗效. 方法回顾分析1993年9月～2003年7月235例经腹腔镜精索静脉高位结扎术的临床资料. 结果 235例手术均获成功,手术时间5～20 min,平均12 min.术后住院2～5 d,平均3 d.210例随访6～18个月,9例复发,复发率4.3%(9/210),不育11例术后6～12个月后其妻受孕. 结论腹腔镜精索静脉高位结扎术微创、美观、疗效好,对双侧精索静脉曲张、开放性手术后复发和有腹股沟区手术史者尤为适用.     

经腹膜后精索内静脉高位结扎治疗精索静脉曲张

目的：探讨经腹膜后小切口精索内静脉高位结扎治疗精索静脉曲张的手术效果。方法：采用麦氏点斜切口经腹膜后途径精索内静脉高位结扎治疗72例(94侧)精索静脉曲张患者。应用罂粟碱试验和阴囊内驱血以辨认精索内动、静脉,结扎静脉,保留动脉。结果：平均手术时间27min。术后3个月随访,2侧(例)复发,占2．1％(2／94)。治愈患者症状减轻或消失。结论：小切口高位腹膜后精索内静脉结扎术是一种创伤小、操作简便、疗效高的手术方法。     

Long-term results of varicocelectomy.

Between 1983 and 1985, 257 infertile men were examined for any present varicocele by means of the Doppler sonography, telethermography and palpation. Based on these findings, the spermiogram and the infertility history, high ligation of the spermatic vein was indicated in 89 patients with varicocele and a median duration of infertility of 36 months (6-88 months). Postoperative sperm examinations have shown a significant improvement in sperm count and morphology, but not in motility. The most significant drop was observed in germ cell concentration from 1.68 to 1.06 mio/ml (p less than 0.025 Wilcoxon signed rank sum test). The follow-up examination 6 years after the beginning of the study has shown that only 56 out of the 89 patients underwent surgery, whereas 33 patients refrained from it. Pregnancy rates were 42% (23 out of 55, 1 patient lost to follow-up) in the operated group and 45% (14 out of 31, 2 patients lost to follow-up) in the nonoperated group. The comparison of the two graphs showing pregnancy incidence clearly demonstrates that pregnancies in the nonoperated group occur earlier than in the operated group; it has to be noted, however, that several patients only refrained from being operated on because pregnancy had occurred before surgery was planned. On the one hand, our study confirms other authors' results, i.e. that pregnancy rates in the nonoperated group are relatively high despite present varicocele. On the other hand, the operated group achieved practically the same high pregnancy rate when monitored over a longer period of time.(ABSTRACT TRUNCATED AT 250 WORDS)     

一孔法腹腔镜下精索内静脉高位结扎42例报告

目的 :总结一孔法腹腔镜下精索内静脉高位结扎的临床经验。方法 :一孔法行腹腔镜下精索内静脉高位结扎术 4 2例 ,其中左侧曲张 35例 ,双侧曲张 7例。结果 :患者手术均获成功 ,无并发症发生 ,平均手术时间 30min ,术后平均住院 3d。结论 :一孔法行腹腔镜下精索内静脉高位结扎术是一种可选的术式 ,患者痛苦小 ,损伤轻 ,恢复快 ,更具有美容、微创的治疗效果 ,但要增加设备 ,操作难度较大 ,对术者的要求更高     

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。     

腹腔镜完全腹膜外补片修补术联合精索静脉高位结扎治疗腹股沟疝合并精索静脉曲张的疗效优势

目的探究腹腔镜完全腹膜外补片修补术（TEP）联合精索静脉高位结扎治疗腹股沟疝合并精索静脉曲张的疗效。 方法回顾性分析2016年3月至2019年5月湖北省公安县人民医院收治的82例腹股沟疝合并精索静脉曲张患者资料。按照治疗方法分为对照组（49例，TEP治疗）和试验组（33例，TEP联合精索静脉高位结扎治疗），比较两组患者手术时间、排气时间、住院时间、治疗前后精液参数、精索静脉曲张疗效及并发症发生情况。 结果试验组患者手术时间、住院时间均长于对照组，差异均有统计学意义（t=40.196、6.893，均P<0.001）。术后7 d比较，试验组精子密度、A级精子比例均高于同期对照组，畸形率更低，差异均有统计学意义（P<0.05）。试验组的精索静脉曲张疗效（Z=15.444，P<0.001）及并发症发生率（χ²=7.009，P=0.008）均显著优于对照组患者。 结论相比于单纯TEP手术，TEP联合精索静脉高位结扎术治疗腹股沟疝合并精索静脉曲张的临床治疗效果较好，患者症状改善时间也相对较短。     

腹腔镜治疗精索静脉曲张118例临床研究

目的:总结腹腔镜治疗精索静脉曲张经验和教训。方法:回顾分析118例腹腔镜下精索静脉高位结扎术的疗效和康复情况。结果:118例手术均获成功,平均手术时间38 min,出现并发症2例,2例术后阴囊气肿。术后平均住院3天,随访3～12个月无复发。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,尤其适用于双侧精索静脉曲张、开放性手术后复发或有腹股沟手术史的患者。