腹腔镜精索静脉高位结扎术中保留睾丸动脉与否的临床对照研究  

A clinical controlled study on the effect of testicular artery ligation or not in laparoscopic high ligation of varicocele

作　　者：甘伟[1] 李云飞[1] 罗茂华[1] 贾洪涛[1] 张少峰[1] 

机构地区：[1]十堰市人民医院泌尿外科,湖北十堰442000

出　　处：《国际泌尿系统杂志》2015年第5期713-715,共3页International Journal of Urology and Nephrology

摘　　要：目的 探讨在腹腔镜精索静脉曲张高位结扎术中保留睾丸动脉的意义.方法 回顾性分析了本单位从2009年3月～2013年12月208例行腹腔镜精索静脉曲张高位结扎手术患者的临床资料,其中保留睾丸动脉仅结扎曲张静脉组81例（A组）,不保留睾丸动脉行精索血管高位集束结扎组127例（B组）;比较两组的手术时间、术后并发症、复发率、术后精液分析结果.结果 两组病例均顺利完成手术,其中8例患者拟保留睾丸动脉,术中因分离辨认动脉困难改行精索血管集束结扎,无中转开放手术.其中,保留睾丸动脉组较集束结扎组手术时间明显延长（P＜0.05）;术后并发症方面,集束结扎组出现4例患侧附睾炎;两组病例术后均未出现睾丸萎缩;两组病例随访0.5 ～5年均未出现复发;两组病例术后精液质量较术前均有明显提高（P＜0.05）,两组间比较术后改善程度差异无统计学意义（P＞0.05）.结论 在腹腔镜精索静脉曲张高位结扎术中,保留睾丸动脉会导致手术时间延长,对精液质量的改善与不保留睾丸动脉作用近似,不增加复发率,但可减少术后患侧附睾炎的发生。Objectives To investigate the effect of testicular artery ligation or not in laparoscopic high ligation of varicocele.Methods Two hundred and eight patients were retrospectively analyzed from March 2009 to december 2013 who underwent laparoscopic high ligation of varicocele by keeping testicular artery for group A （n =81） and not keeping testicular artery for group B（n =127）.Operative time,the incidence of complications,recurrence rate and semen analysis of two groups in the preoperative and postoperative were compared and analyzed.Results All patients were successfully operated and without conversion to open surgery in two groups,8 patients were converted to non-reserved artery laparoscopic ligation of the spermatic due to difficulties in the identification and separation of arterial on group A,operative time of group A was significantly longer than group B（P 〈 0.05）.In addition,4 cases of epididymitis,two cases of hydrocele were observed in group B,testicular atrophy and varicocele recurrence was not observed in two groups.The postoperative clinical observation for 0.5 to 5 years,postoperative semen quality were significantly improved compared with the preoperative in both groups（P 〈 0.05）.However,there was no significant difference in semen quality improvement between group A and group B （P 〉 0.05）.Conclusions Laparoscopic high ligation of varicocele by keeping testicular artery may lead to prolonged operative time and its improvement of the quality was similar to the non-reserved spennatic artery,does not increase the recurrence rate can reduce the incidence of postoperative epididymitis.

关 键 词：精索静脉曲张 结扎术 

分 类 号：R697.24[医药卫生—泌尿科学]