“S.L.O.T.S.”三层五步法保留睾丸动脉在显微镜腹股沟下精索内静脉结扎术中的应用  

Application of“S.L.O.T.S.”Three-layer Five-step Method to Preserve Testicular Artery in Microsurgical Subinguinal Varicocelectomy

作　　者：曾圣涛 杨成林 王尉 吴实坚 杨悦 曹智 胡正飞 Zeng Shengtao;Yang Chenglin;Wang Wei(不详;Department of Urology,General Hospital of Southern Theater Command of Chinese People’s Liberation Army,Guangzhou 510010,China)

机构地区：[1]南方医科大学第一临床医学院,广州510515 [2]中国人民解放军南部战区总医院泌尿外科,广州510010

出　　处：《中国微创外科杂志》2025年第4期204-209,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：广州市校(院)企联合资助项目(2024A03J0641);广州市科技计划(202002030030);广东省基础与应用基础研究基金(2020A1515010044)。

摘　　要：目的探讨“S.L.O.T.S.”(Separate分离、Loop打结、Observe观察、Tension升压、Sign标记)三层五步法保留睾丸动脉在显微镜腹股沟下精索内静脉结扎术的临床疗效。方法回顾性分析2020年3月~2022年9月我院190例精索静脉曲张的临床资料,97例行显微镜下“S.L.O.T.S.”三层五步法保留睾丸动脉的腹股沟下精索内静脉结扎术(显微镜组),93例行腹腔镜下精索内静脉集束结扎术(腹腔镜组),比较2组手术前后患者精液质量和术后并发症等指标。结果腹腔镜组手术时间明显短于显微镜组[(32.2±7.3)min vs.(65.1±8.3)min,t=28.959,P=0.000]。显微镜组术后继发性鞘膜积液[1.0%(1/97)vs.8.6%(8/93),χ^(2)=4.470,P=0.034]、附睾炎[2.1%(2/97)vs.9.7%(9/93),χ^(2)=5.049,P=0.025]和总并发症[3.1%(3/97)vs.21.5%(20/93),χ^(2)=15.128,P=0.000]发生率明显低于腹腔镜组。显微镜组术后精子总数[(53.3±5.8)×10^(6) vs.(50.4±4.9)×10^(6),t=3.676,P=0.000]、精子浓度[(19.6±2.2)×10^(6)/ml vs.(18.1±2.4)×10^(6)/ml,t=4.418,P=0.000]、精子前向运动力[(46.1±5.6)%vs.(41.5±4.1)%,t=6.476,P=0.000]、精子总活力[(55.7±4.9)%vs.(51.2±3.8)%,t=7.115,P=0.000]、正常精子比例[(9.0±1.7)%vs.(7.6±1.6)%,t=5.550,P=0.000]明显优于腹腔镜组。结论显微镜腹股沟下精索内静脉结扎术采用“S.L.O.T.S.”三层五步法能程序化手术步骤,准确有效地识别并保留睾丸动脉和淋巴管,有益于提高精液质量,减少术后继发性鞘膜积液、附睾炎等并发症。Objective To explore the clinical efficacy of the“S.L.O.T.S.”(Separate,Loop,Observe,Tension,Sign)three-layer five-step method for preserving testicular artery in microsurgical subinguinal varicocelectomy.Methods Clinical data of 190 patients with varicocele in our hospital from March 2020 to September 2022 were retrospectively analyzed.A total of 97 cases underwent“S.L.O.T.S.”three-layer five-step method with preservation of testicular artery in microsurgical subinguinal varicocelectomy(microscopic group),and 93 cases underwent laparoscopic spermatic vein bundle ligation(laparoscopic group).The semen quality and postoperative complications of the two groups were compared before and after surgery.Results The laparoscopic group had significantly shorter operation time[(32.2±7.3)min vs.(65.1±8.3)min,t=28.959,P=0.000]compared to the microscopic group.The proportion of postoperative secondary hydrocele[1.0%(1/97)vs.8.6%(8/93),χ^(2)=4.470,P=0.034],epididymitis[2.1%(2/97)vs.9.7%(9/93),χ^(2)=5.049,P=0.025],and total complications[3.1%(3/97)vs.21.5%(20/93),χ^(2)=15.128,P=0.000]in the microscopic group were significantly lower than those in the laparoscopic group.The indicators of semen quality such as total number of sperm[(53.3±5.8)×10^(6) vs.(50.4±4.9)×10^(6),t=3.676,P=0.000],sperm concentration[(19.6±2.2)×10^(6)/ml vs.(18.1±2.4)×10^(6)/ml,t=4.418,P=0.000],rate of sperm anterior motility[(46.1±5.6)%vs.(41.5±4.1)%,t=6.476,P=0.000],total sperm motility[(55.7±4.9)%vs.(51.2±3.8)%,t=7.115,P=0.000],and percentage of normal sperm[(9.0±1.7)%vs.(7.6±1.6)%,t=5.550,P=0.000]were significantly better in the microscopic group than those in the laparoscopic group.Conclusion“S.L.O.T.S.”three-layer five-step method has advantages of programmed surgical steps,and effective identification and preservation of testicular arteries and lymphatic vessels,which is beneficial for improving semen quality and reducing postoperative complications such as secondary hydrocele and epididymitis.

关 键 词：精索内静脉结扎术 显微手术 睾丸动脉 

分 类 号：R6[医药卫生—外科学]