精索静脉显微集束结扎的手术效率及安全性研究

Efficiency and safety of microsurgical cluster ligation of the spermatic vein

目的:探索精索静脉显微集束结扎术的手术效率及安全性。方法:选取2020年7月至2022年6月在徐州市中心医院行显微镜双侧精索静脉结扎的患者为研究对象,患者左右两侧精索分别采用精索静脉显微集束结扎术(MVCL)和精索静脉显微结扎术(MVL)两种不同的手术方案,电脑随机法分配。根据手术方式命名术侧,即MVCL侧和MVL侧。术中记录手术每侧的精索静脉结扎用时、出血量、结扎精索静脉数量及保留的动脉和淋巴管数量;由对术侧手术方式不知情的医生收集患者术后各时期的疼痛评分、结节异物感、阴囊坠痛缓解情况、并发症及远期复发情况,并将结果进行比较。结果:MVCL侧精索静脉结扎用时明显低于MVL侧[(31.43±10.13)min vs(56.21±13.96)min,P<0.01],MVCL侧术后第1天VAS评分明显低于MVL侧[(3.64±1.02)分vs(4.36±1.09)分,P<0.05],MVCL侧术后1个月阴囊内结节异物感发生率明显低于MVL侧(P均<0.05);两侧术中出血量、结扎精索静脉数量、保留的动脉及淋巴管数量、术后第3、7天VAS评分、并发症及远期复发情况无显著差异(P均>0.05)。结论:与MVL相比,MVCL有效降低精索静脉结扎用时、提高手术效率,同时又有效保证手术安全性及疗效,值得临床推广。

Objective:To study the effect and safety of microscopic varicocele cluster ligation(MVCL).Methods:We selected 28 patients undergoing bilateral microscopic spermatic vein ligation in Xuzhou Central Hospital from July 2021 to June 2023.Using the computerized randomization method,we performed MVCL or microscopic varicocele ligation(MVL)for the right or the left spermatic cord,respectively.We recorded the operation time,intraoperative blood loss,the numbers of the spermatic veins ligated and the arteries and lymphatic vessels preserved in each surgical side.A surgeon unaware of the surgical approach on the operative side collected the Visual Analogue Scale(VAS)pain scores,nodular foreign body sensation,relief of scrotal cramps,complications,and long-term recurrence from the patients.Results:Compared with the MVL group,the MVCL group showed significantly shorter time for spermatic vein ligation([56.21±13.96]vs[31.43±10.13]min,P<0.01),lower VAS scores on the 1st postoperative day(P<0.05)and a lower incidence of intra-scrotal nodular foreign body sensation in the 1st postoperative month(P<0.05).There were no statistically significant differences in the intraoperative blood loss,numbers of spermatic veins ligated and arteries and lymphatic vessels preserved,VAS scores at 3 and 7 postoperative days,incidence of complications and long-term recurrence between the two groups(P>0.05).Conclusion:MVCL is superior to MVL in reducing the time of spermatic vein ligation and improving the efficiency,efficacy and safety of the procedure,and therefore worthy of clinical promotion.