腹腔镜下精索血管集束状结扎术临床疗效分析

目的:比较腹腔镜下高选择性精索内静脉结扎术与腹腔镜下精索血管集束状结扎术(Palomo术式)治疗精索静脉曲张的临床疗效。方法:总结研究2009年8月～2011年10月采用腹腔镜下治疗Ⅱ度以上精索静脉曲张的临床资料,其中行腹腔镜保留精索动脉及淋巴组织的高选择性精索内静脉高位结扎术(A组)35例,腹腔镜精索血管高位集束状结扎术(B组)37例。回顾性分析两组患者术后复发率、鞘膜积液发生率及精液质量、睾丸体积等指标,比较其临床疗效。结果:72例手术均获成功,术后随访2年,两组均各失访1例,两组手术方式时间分别为A组(41.1±9.2)min、B组(21.3±3.8)min,两组术后精液质量均较术前有明显提高(P<0.05),但组间比较差异无统计学意义(P>0.05);术后睾丸鞘膜积液差异无统计学意义(P>0.05);术后患侧睾丸血供均无减少,未出现睾丸体积减小等并发症;但是两组复发率差异具有统计学意义(P<0.05)。结论:腹腔镜下高选择性精索内静脉高位结扎术与Palomo术均是治疗精索静脉曲张行之有效的手术方法,但是Palomo术较之前者具有操作更简便、手术时间更短、复发率更少等优点,更具有临床推广价值。

Clinical effects of internal spermatic vein ligation under laparoscopy for the treatment of spermatic varicocele

Objective: To compare the curative effects of selective internal spermatic vein ligation and cluster spermatic vein ligation,both conducted under laparoscopy.Methods:Data of 72 cases with gradeⅡspermatic varicocele that were treated with laparoscopic surgery during August 2009 and October 2011 were enrolled into this study,of which 35 cases underwent selective internal spermatic vein ligation(Group A)and 37 had cluster spermatic vein ligation(Group B).Rate of recurrence,incidence of hydrocele,semen quality,testicular volume index were retrospectively analyzed,and clinical efficacy were compared between the two groups.Results:Surgery were successfully performed in all cases,except 1 case in each group,2-year follow up was conducted.The mean operative times of group A and B was(41.1±9.2)min vs.(21.3±3.8)min,respectively.The quality of semen of both group were significantly improved(P<0.05) after the surgery,but no significant difference was found between the two groups(P>0.05).No significant difference in hydrocele ipsilateral testicular blood supply,or testicular volume was found after surgery(P all>0.05).Incidence of postoperative complications was significant different between the two groups(P<0.05).Conclusions:Both selective internal spermatic vein ligation and cluster spermatic vein ligation are effective treatment for varicoele,but Palomo′s technique(cluster spermatic vein ligation) has the advantages of simpler procedure、shorter duration of operation and lower recurrence rate,and can be regarded as better laparoscopic treatment for varicocele.