腹腔镜下保留精索内动脉的精索静脉高位结扎术700例总结报告  

Laparoscopic Ligation of the Internal Spermatic Vein with Preservation of the Testicular Artery in the Treatment of Varicocele: A Report of 700 Cases

作　　者：夏亭[1] 徐伟[1] 张磊[1] 翟星全[1] 周继宝[1] 刘啸[1] 熊晖[2] 

机构地区：[1]邹城市人民医院泌尿外科,山东邹城273500 [2]山东大学附属省立医院泌尿微创中心,山东济南250014

出　　处：《泌尿外科杂志（电子版）》2014年第1期29-32,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的评价腹腔镜保留精索内动脉的精索静脉高位结扎术的效果及价值。方法回顾分析自2007年1月至2014年1月在我科室应用钛夹、超声刀、丝线结扎等不同方式行腹腔镜下保留精索内动脉的精索静脉高位结扎术患者700例的临床资料,探讨腹腔镜下保留精索内动脉的精索静脉高位结扎术的安全性及有效性,并对治疗效果、并发症及手术经验等进行总结分析。结果 700例精索静脉曲张患者,年龄16~46岁(平均27岁);其中单侧精索静脉曲张患者482例,双侧精索静脉曲张患者218例,均采用腹腔镜行双侧精索静脉高位结扎术,术中均分离并保留双侧精索内动脉。其中钛夹组患者150例,超声刀组患者200例,丝线结扎组患者350例。手术时间30分钟~60分钟,平均手术时间43分钟;住院时间3~5天。术后患者均取得较满意治疗效果,阴囊坠胀不适感明显改善,不育患者复查精液显示精子质量较术前明显提高。术中出现皮下气肿患者18例,术后出现睾丸鞘膜积液者12例,睾丸炎者8例,术后复发者5例,均经保守治疗或二次手术后治愈。无输精管损伤、睾丸萎缩病例发生。结论腹腔镜保留精索内动脉的精索静脉高位结扎术能更大限度保留睾丸血供,具有简便、微创、并发症少、效果可靠、术后恢复快等的优点,尤其适用于双侧精索静脉曲张、具有腹股沟区手术史、术后复发等患者,是治疗精索静脉曲张的有价值的方法,可作为手术治疗的首选方式。Objective To evaluate the effect and value of laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery in the treatment of varicocele. Methods To investigate the safety and ef-ficacy and summarize the treatment outcome,complications and surgical experience,the clinical data of 700 pa-tients who underwent laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery from January 2007 to January 2014 in our department were retrospectively analyzed. Results 700 cases of varico-cele patients,aged 16 to 46 years (mean 27 years),482 unilateral and 218 bilateral,were all underwent lapa-roscopic ligation of the internal spermatic vein with preservation of the testicular artery. Titanium clip,ultrasonic scalpel and silk were applied in 150 cases,200 cases and 350 cases for the ligation of the spermatic vein. The operation time was 30min to 1h,the average time was 43min;the hospitalization time was 3 to 5 days. Most pa-tients achieved satisfactory therapeutic effect to get significant improvement in the scrotum bulge discomfort and quality of infertility sperm compared with the preoperative patients. 18 patients occurred intra-operative subcu-taneous emphysema,after surgery,12 cases occurred hydrocele,8 cases occurred orchitis and 5 cases recur-rence. All of them were cured after conservative treatment or secondary surgery. No cases of the vas deferens damage and testicular atrophy occurred. Conclusions Laparoscopic ligation of the internal spermatic vein with preservation of the testicular artery,retaining testicle blood supply to a greater extent,with advantages of simple, minimally invasive,fewer complications,reliable effect and faster recovery,etc. ,especially proper for bilateral varicocele,patients with history of groin surgery,recurrence cases,is a valuable method of varicocele treatment, can be the preferred method of surgical treatment.

关 键 词：腹腔镜 精索静脉高位结扎 精索静脉曲张 

分 类 号：R699[医药卫生—泌尿科学]