新型单孔腹腔镜治疗精索静脉曲张的临床疗效观察  

Effect of single hole laparoscopic treatment of varicocele and influence on testis hemodynamics,semen quality and immune function

作　　者：邹火生[1] 黄裕清[1] 余自强[1] ZOU Huosheng HUANG Yuqing YU Ziqiang(Department of Urinary Surgery, Meizhou People Hospital, Miezhou 514031, Guangdong, China)

机构地区：[1]梅州市人民医院泌尿外科,广东梅州514031

出　　处：《西部医学》2017年第2期214-217,221,共5页Medical Journal of West China

基　　金：广东省科技计划项目(2012B031800361);梅州市医药卫生科研课题(2014-B-4)

摘　　要：目的探讨新型单孔腹腔镜治疗精索静脉曲张的临床疗效及对睾丸血流动力学、精液质量和免疫功能的影响。方法选取2008年7月至2015年6月本院收治的60例精索静脉曲张患者,根据抛硬币法随机分为观察组和对照组,每组30例。对照组采取开放手术,观察组采取新型单孔腹腔镜手术。比较两组患者的临床疗效、手术时间、术后疼痛程度、住院时间。观察两组患者手术前后睾丸血流动力学、精液质量及免疫功能改善情况。结果观察组总有效率90.00%(27/30)高于对照组46.67%(14/30)(P<0.05)。观察组手术时间、术后疼痛评分低于对照组(P<0.05),两组患者的住院时间比较差异无统计学意义(P>0.05)。观察组搏动指数(0.72±0.08)、阻力指数(0.51±0.08)、收缩期峰值流速(6.02±0.64)cm/s低于对照组(0.87±0.12)、(0.56±0.09)、(6.46±0.73)cm/s(P<0.05)。观察组精子活力(63.43±4.57)%、精子密度(48.53±4.21)×106/ml、精液量(3.48±0.54)ml高于对照组(53.25±4.12)%、(41.48±3.18)×106/ml、(2.69±0.48)ml(P<0.05)。观察组CD4(38.15±3.82)%、CD4/CD8(1.54±0.55)免疫功能指标高于对照组(31.43±2.87%)、(1.14±0.21)(P<0.05),CD8(23.87±2.45)%低于对照组(28.98±2.87)%(P<0.05)。结论新型单孔腹腔镜治疗精索静脉曲张的可有效改善睾丸血流动力学和精液质量,并不会降低患者的免疫功能,临床疗效良好,值得推广。Objective To study the clinical effect of new single hole laparoscope on treatment of varicocele and in- fluence on testis hemodynamics, semen quality and immune function. Methods 60 patients with varicocele were divided into observation group （30 cases） and control group （30 cases）. The control group was treated with open surgery. The observation group was treated with a new single hole laparoscopic surgery. The clinical efficacy, operative time, postoperative pain and hospital stay were compared between the two groups. The hemodynamics, semen quality and immune function of the two groups were observed before and after operation. Results The total effective rate in the observation group （90.00%） was significantly higher than that in the control group （46.67X） （P〈0.05）. The operative time and postoperative pain scores of the observation group were significantly lower than those of the control group （P〈0.05）. The pulsatility index, resistance index and peak systolic velocity of the observation group were significantly lower than that of the control group （P〈0.05）. The sperm motility, sperm density and semen volume of the observation group of the observation group were significantly higher than those of the control group （P〈0.05）. CD4, CD4 / CD8 of the observation group were significantly higher in that of the control group （P〈0.05）. CD8 of the observation group was significantly lower than that of the control group （P〈0.05）. Conclusion The new type of single laparoscopic treatment of varicocele can effectively improve testicular hemodynamics and semen quality and will not reduce the patient＇s immune function.

关 键 词：单孔腹腔镜 精索静脉曲张 血流动力学 精液质量 免疫功能 

分 类 号：R697.24[医药卫生—泌尿科学]