腹腔镜精索动静脉结扎手术治疗小儿精索静脉曲张疗效分析  

Surgical treatment of varicocele in children with laparoscopic cluster ligation of the internal spermatic veins and arteries

作　　者：邱颖[1] 白东升[1] 叶辉[1] 郝春生[1] 牛志尚[1] 宋晋秋[1] 张晨捷 王弘扬 刘晓萌 孙清[1] 马岩 Qiu Ying;Bai Dongsheng;Ye Hui;Hao Chunsheng;Niu Zhishang;Song Jinqiu;Zhang Chenjie;Wang Hongyang;Liu Xiaomeng;Sun Qing;Ma Yan(Department of Pediatric Urology,Children's Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院泌尿外科,北京100020

出　　处：《北京医学》2018年第11期1044-1047,共4页Beijing Medical Journal

基　　金：北京市医院管理局青年人才培养"青苗"计划(QML20171303)

摘　　要：目的探讨腹腔镜精索动静脉结扎术治疗小儿精索静脉曲张的手术方法及治疗效果。方法选择2015年1月至2018年4月首都儿科研究所附属儿童医院收治并行腹腔镜精索动静脉结扎术的精索静脉曲张患儿91例,年龄10～14岁,平均12.4岁。均为左侧发病,发病时间2～48个月,平均16个月。诊断明确后行经腹腔镜精索动静脉高位结扎术。术前及术后超声评估静脉直径、双侧睾丸体积。结果 91例患儿手术时间20～50 min,平均33 min。全部患儿恢复顺利,无发热、伤口感染及睾丸肿胀等早期并发症。76例(83.5%)获得随访并行超声检查,术后6个月超声检查显示,左侧精索静脉最宽处与术前相比,平均降低了53.2%(15.6%～64.0%)。随访患儿,术后3个月、6个月、12个月时患侧睾丸平均体积与对侧相比差异均无统计学意义。所有患儿均未复发,未发生睾丸萎缩,其中8例患儿术后发现患侧鞘膜积液,定期复查均有好转。结论腹腔镜治疗小儿精索静脉曲张具有操作简单、创伤小、恢复快、并发症少的优点,是治疗小儿精索静脉曲张安全有效的方法。Objective To analyze the therapy effects of the procedure of laparoscopic cluster ligation of the internal spermatic veins and arteries on treatment of varicocele in children. Methods From January 2015 to April 2018, 91 patients, aged from 10 to 14 years old(median age 12.4) underwent varicocele ligation using the technique for complete ligation of the internal spermatic veins and arteries. Postoperative follow-up was 3 to 24 months. A total of 76 patients had at least a 3 month follow-up including scrotal ultrasound. Results All patients had an successful operation, and the symptoms had been improved obviously. Mean operative time was 33 min(25~50 min). No postoperative recurrence or testicular atrophy was reported. Six months after operation, the diameter of internal spermatic veins was 15.6%~64.0%(53.2%)lower than that before operation. The mean testicular volume of the left side was not significantly different from that of the contralateral side at 3 months, 6 months and 12 months after operation. Eight patients(10.5%) developed hydrocele, all of which relieved slowly during our follow-up. Conclusions The procedure of cluster ligation of the internal spermatic veins and arteries for varicocele repair is safe and effective with a high success rate and low complication rate.

关 键 词：精索静脉曲张 腹腔镜 动静脉集束结扎 

分 类 号：R726.9[医药卫生—儿科]