经腹膜后精索静脉高位结扎术与腹腔镜下改良Palomo术治疗精索静脉曲张的疗效比较

目的：比较经腹膜后精索静脉高位结扎术与腹腔镜下改良Palomo术两种方法治疗精索静脉曲张的效果。方法：收集我院1994年1月～2008年11月行手术治疗并获得随访的Ⅱ度及以上的精索静脉曲张患者305例，根据手术分为两组：A组263例行经腹膜后精索静脉高位结扎术；B组42例行腹腔镜下改良palomo术。对比观察两组术后阴囊水肿、辜丸萎缩、复发等，近、远期并发症及精液质量改善和生育情况。结果：术后阴囊水肿发生率B组为16．7％，A组为2．3％，两组比较差异有统计学意义（P〈0．05）；术后3个月睾丸萎缩发生率B组为9．5％，A组为1．1％，两组比较差异有统计学意义（P〈0．05）；≤30岁患者A组术后6个月精液质量提高率为82％，高于B组术后6个月的74．2％（P〈0．05）；两组≤30岁患者术后1～2年内配偶自然怀孕率为69．5％、55．6％，A组高于B组（P〈0．05）。结论：经腹膜后精索静脉高位结扎术术式简单易掌握且术后阴囊水肿和睾丸萎缩发生率低，术后精液质量提高率和术后1～2年内配偶自然怀孕率高，值得广泛推广。

The Comparation Between High Ligation of Internal Spermatic Veins Through Meta-peritoneum and Modified Laparoscopic Palomo Operation for Varicocele

Objective:To discuss treatment effect between high ligation of internal spermatic veins through meta-peritoneum and modified Laparoscopic palomo operation for varicocele. Methods: From Jan. 1994 to Nov. 2008, total 305 cases of varicoeele with the degree Ⅱ or above were reviewed, two operative groups: 263 cases in group A were treated with high ligation of internal spermatie veins through meta-peritoneum; 42 cases in group B were treated with modified laparoscopie palomo operation. To observe the complication of scrotal edema testicular atrophy, recurrence and the improvement of semen quality and gestation post-operatively. Results: The incidence rate of scrotal edema and testicular atrophy was significantly difference between tqo groups (2.3%, 1.1% vs 16.7%, 9.5% )(P<0.05) ; The improvement of semen quality was 82% in group A and 74.2% in group B of lower 30 years old in 6 month post-operatively, respectively(P< 0.05);the natural rate of gestation of lower 30 years old in group A was higher than group B in next 1～2 years post-operatively (69.5 % vs 55.6 % )(P<0.05). Conclusions : Compared with modified Laparoscopic palomo operation, high ligation of internal spermatic veins through meta-peritoneum was simple and easily to study, because of lower scrotal edema, testicular atrophy and better semen quality and gestation, which was worthy for generalization.