双孔三通道腹腔镜与显微外科手术治疗精索静脉曲张对比分析  

Comparative study between two-port including three trocars laparoscopic and microscopic varicocelectomy

作　　者：朱智荣[1] 阎家骏[1] 王亚佟[2] 吴刚锋 潘建刚[1] 

机构地区：[1]绍兴市人民医院/浙江大学绍兴医院泌尿外科,绍兴312000 [2]汉中市中心医院泌尿外科

出　　处：《中国男科学杂志》2015年第5期43-46,50,共5页Chinese Journal of Andrology

基　　金：浙江绍兴市科技局社会发展科研项目(2012B70080)

摘　　要：目的比较双孔三通道腹腔镜与显微外科手术治疗精索静脉曲张的疗效及并发症。方法2012年1月至2013年9月将33例精索静脉曲张患者随机分成两组：双孔三通道腹腔镜精索静脉高位结扎术组（18例），显微镜下精索静脉结扎术组（15例）。对两组患者临床疗效及并发症进行对比分析。术后3月对切口美观度进行评分。结果双孔三通道腹腔镜组手术时间明显短于显微外科组（p〈0．05），两组住院时间比较差异不显著。双孔三通道腹腔镜与显微外科精索静脉结扎术后精子浓度、精子活动率与（a＋b）级精子百分率均较术前明显改善（p〈0．05），两组之间比较无统计学差异（p〉0．05）。双孔三通道腹腔镜组术后随访1例患侧出现睾丸鞘膜积液，1例精索静脉曲张复发，而显微外科组无鞘膜积液及复发，两组均未见睾丸萎缩。观察术后3月切口美观度双孔三通道腹腔镜组优于显微外科组，评分比较差异有统计学意义（p〈0．05）。结论双孔三通道腹腔镜及显微外科精索静脉高位结扎术均具有创伤小、恢复快和疗效确切等优点。显微外科并发症少，复发率低；双孔三通道腹腔镜手术简便，学习曲线短，美观效果突出，便于基层医院推广与普及。Objective To compare the effect and complication of the two-port including three trocars laparoscopic varicocelectomy and microsurgical varicocelectomy in the treatment of varicocele. Methods A total of 33 patients with varicocele were divided randomly into two groups and 18 patients received laparoscopic high ligation of spermafic vein with two-port including three trocars, 15 patients underwent microsurgical varicocelectomy. The clinical effect and complication of the treated patients were comparatively analyzed and actual scar satisfaction of two surgical operation was evaluated after three months. Results The operation time of the two-port including three trocars laparoscopic varicocelectomy group was shorter than that of microsurgical varicocelectomy group. However, there was no significant difference in the hospital stay. Preoperative semen indicators showed no statistically significant difference. Three months after the surgery, the sperm concentration, the sperm motility and the Grade （a＋b） sperm count percentage of both groups were all improved（P〈0.05）, and no significant differences betwenthe two groups（P〉0.05）. Postoperative hydrocele and recurrence respectively occurred in 1 case in the two-port including three trocars laparoscopic varicocelectomy group,but none in the microsurgical varicocelectomy group,no testicular atrophy was observed postoperatively in both groups .However, incision scar in the two-port including three trocars laparoscopic varicocelectomy was smaller than that in the microsurgical varicocelectomy group, indicating better cosmetic result （P〈0.05）. Conclusion Both the microsurgical varicocelectomy and the two-port including three trocars laparoscopic varicocelectomy are minimal invasive and effective ways for varicocele treatment, however, the former is fewer complication and lower recurrence, the latter is simpler, more beautiful and facilitates grassroots promotion.

关 键 词：精索静脉曲张 腹腔镜检查 显微外科手术 对比研究 

分 类 号：R697.24[医药卫生—泌尿科学]