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。

Comparison between palomo operation and high ligation operation of internal spermatic vein

Objective To evaluate the results and complications of high mass retroperitoneal ligation (Palomo operation) and high ligation operation of internal spermatic vein on the patients with varicocele. Methods We compared the results and complications of the two approaches from July 2000 to June 2006, including 25 cases of Palomo operation and 30 cases of high ligation operation. Results All operation had succeeded. The clinical symptom of the 25 patients with Palomo operation disappeared and all varicose veins decreased 3-10 days after operation. The duration of surgery was 12 to 18 min. 18 cases underwent follow-up for 6 months to 2 years. At the end of follow-up we found no case of testicular atrophy and recurrences of varicocele. 3/18 cases (16.6%) developed left hydrocele. one case developed chronic epididymitis and one case testis pain (no other cause). The varicose veins of 29 patients with high ligation operation of internal spermatic vein decreased 1-8 days after operation. one case had varicocele persistence.The duration of surgery was 20 to 35 min. Of the 20 cases followed up, 3 cases recurred (15%). The high ligation operation of internal spermatic vein resulted in a significant increase in the relapse rate compared with the Palomo operation group (P<0.05). More complications were observed in the Palomo operation group (P<0.05). The average duration of surgery was significantly shorter in the Palomo operation group than in the high ligation operation group(P<0.01). Conclusion Palomo's technique is a fast, easy, effective method for varicocele treatment, but it has some side effects.