不同手术方案治疗精索静脉曲张症疗效比较  

Comparison of different surgical procedures for the treatment of patients with varicocele

作　　者：程曙杰 屈平保 　CHENG Shujie;QU Pingbao(Department of Urology,Tongren Hospital Shanghai Jiaotong University School of Medicine,Shanghai 200336 China)

机构地区：[1]上海市同仁医院泌尿外科,上海200036

出　　处：《现代仪器与医疗》2016年第6期42-44,共3页Modern Instruments & Medical Treatment

摘　　要：目的 :比较不同手术方案治疗精索静脉曲张症的疗效、安全性与经济性。方法 :2011年5月—2015年5月收治的78例精索静脉曲张症患者,按照患者意愿将其纳入开放组(n=22)、腹腔镜组(n=38)、显微镜组(n=18),分别实施开放手术、腹腔镜下、显微镜下精索静脉结扎,比较3组患者手术、恢复情况、并发症发生情况及手术前后睾丸血流动力学参数变化。结果 :腹腔镜组、显微镜组术后2 h VAS评分、出院至恢复工作时间、治疗费用均低于开放组,腹腔镜组、开放组、显微镜组手术时间依次增加,腹腔镜组、显微镜组、开放组住院时间依次增加;腹腔镜组、显微镜组并发症发生率低于开放组,差异有统计学意义(P<0.05)。3组患者术后6个月精子密度、前向运动、EDV均较术前升高,PSV、RI、PR均较术前降低,腹腔镜组、显微镜组变化更为明显,差异有统计学意义(P<0.05)。结论 :与传统开放手术相比,腹腔镜、显微镜下精索静脉结扎能够在保证治疗效果的基础上降低术后并发症发生风险,鉴于显微镜技术手术时间较长、操作稍显复杂的弊端,腹腔镜术式可作为精索静脉曲张症的首选方案。Objective:This study aimed to compare the efficacy,safety and economy of different surgical proceduresfor the treatment of the patients with the varicocele.Methods:78cases of patients with varicocele hospitalized inour hospital from May2011to May2015,included in the open surgery group(n=22)and laparoscopy group(n=38),microscopy group(n=18)according to the wishes of patients,respectively conducted the spermatic vein ligation in opensurgery,under the laparoscope and microscope,operation,recovery,complication,testicular hemodynamic parameterschanges before and after surgery were compared among three groups of patients.Results:VAS scores evaluated at2hafter surgery,the duration from the discharge to return to work,treatment costs in the laparoscopy group and microscopygroup,were all lower than in the open surgery group,and the time of operation increased in parallel with the sequence oflaparoscopy group,open surgery group and microscopy group,the time of hospitalization increased in parallel with thesequence of laparoscopy group,microscopy group and open group;incidences of complications in laparoscopic groupand microscope group were both lower than in open surgery group,the differences were statistically significant(P<0.05).Sperm density,forward movement and EDV of the three groups of patients6months after surgery were all higher thanthose before operation,PSV,RI and PR in three groups were all lower as compared with the preoperation,the change ingroups of laparoscopy and microscopy were more significantly,the differences were statistically significant(P<0.05).Conclusions:Compared with traditional open surgery,spermatic vein ligation under laparoscope and microscope,canreducing the risk of postoperative complications on the basis of guaranteing treatment effect,in view of the shortcomingsof microscopy,long operation time and complicated performance,laparoscopy may be the first choice for treatment ofvaricocele.

关 键 词：开放 显微镜 腹腔镜 精索静脉结扎 精索静脉曲张 

分 类 号：R697[医药卫生—泌尿科学]