经脐单孔腹腔镜下精准五步法保留睾丸动脉的精索内静脉高位结扎术治疗精索静脉曲张  

Transumbilical single port laparoscopy varicocelectomy with accurate five⁃step procedure for testicular ar⁃tery preservation in the treatment of varicocele

作　　者：杨成林 王凯强 王尉 曹智 杨悦 肖远松 张小明 张惠芬 YANG Chenglin;WANG Kaiqiang;WANG Wei;CAO Zhi;YANG Yue;XIAO Yuansong;ZHANG Xiaoming;ZHANG Huifen(Department of Urology,the General Hospital of Southern Theater Command,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院泌尿外科,广州510010

出　　处：《实用医学杂志》2023年第7期881-885,共5页The Journal of Practical Medicine

基　　金：广州市科技计划项目(编号:202002030030);广东省基础与应用基础研究基金项目(编号:2020A1515010044);军队护理创新与培育专项计划(培育)项目(编号:2021HL052);军队医学科技青年培育计划项目(编号:21QNPY125)。

摘　　要：目的探讨经脐单孔腹腔镜下精准五步法保留睾丸动脉的精索内静脉高位结扎术在精索静脉曲张治疗中的应用。方法回顾性分析2019年1月至2020年6月收治的36例精索静脉曲张患者资料,行经脐单孔腹腔镜下精准五步法保留睾丸动脉的精索内静脉高位结扎术。统计手术时间、对比手术前后患者的精液质量及阴囊坠胀症状,评估术后并发症等情况。结果36例患者手术均成功,单侧手术时间(33.21±4.34)min,双侧手术时间(57.57±5.83)min。患者切口均为一期愈合,术后住院时间2~4 d。与术前相比,术后6个月精子总数[(37.89±4.81)×10^(6)vs.(48.03±4.63)×10^(6)]、精子浓度[(13.22±1.64)×10^(6)/mL vs.(17.06±2.64)×10^(6)/mL]、精子总活力(PR+NP)[(38.44±5.86)%vs.(50.50±6.38)%]、前向运动精子率(PR)[(30.64±4.20)%vs.(39.83±6.24)%]均升高,差异均有统计学意义(P<0.001);术后6个月复查随访,所有患者均无睾丸萎缩、附睾炎、阴囊水肿、睾丸鞘膜积液、精索静脉曲张复发。结论经脐单孔腹腔镜下精准五步法保留睾丸动脉的精索内静脉高位结扎术具有精准保留睾丸动脉、恢复快和并发症少的优点,有临床推广应用价值。Objective To investigate the effect of transumbilical single port laparoscopy varicocelectomy with precise five⁃step procedure for testicular artery preservation in the treatment of varicocele.Methods The clinical data of 36 varicocele patients treated with transumbilical single port laparoscopy varicocelectomy with pre⁃cise five⁃step procedure for testicular artery preservation between January 2019 and June 2020 in Department of Urology,the General Hospital of Southern Theater Command were retrospectively analyzed to investigate operation time,preoperative and postoperative semen quality and symptoms of scrotal pain,and postoperative complications.Result All the surgical operations for the 36 patients were completed successfully.The unilateral operation time was(33.21±4.34)min and the bilateral operation time was(57.57±5.83)min.The incisions in all the patients were primarily healed.The postoperative hospitalization time was 2~4 days.Compared with the preoperative data,the total number of sperm[(37.89±4.81)×10^(6) vs.(48.03±4.63)×10^(6)],sperm concentration[(13.22±1.64)×10^(6)/ml vs.(17.06±2.64)×10^(6)/mL],(PR+NP)total sperm motility[(38.44±5.86)%vs.(50.50±6.38)%],and PR forward motile sperm rate[(30.64±4.20)%vs.(39.83±6.24)%]were significantly increased.There was no testic⁃ular atrophy,epididymitis,scrotal edema,testicular hydrocele and recurrence of varicocele at 6 months after oper⁃ation.Conclusion Transumbilical single port laparoscopy varicocelectomy with precise five⁃step procedure for tes⁃ticular artery preservation has the advantages of accurate preservation of testicular artery,rapid recovery and less complications,worthy of popularization.

关 键 词：单孔腹腔镜手术 精索内静脉高位结扎术 精索静脉曲张 睾丸动脉 

分 类 号：R697.24[医药卫生—泌尿科学]