经脐三孔法在腹腔镜精索静脉高位结扎术中应用的研究

The Application of Umbilical Three Spots Technique in Laparoscopic Varicocelectomy

目的研究经脐三孔法在腹腔镜精索静脉高位结扎术中的应用及临床意义。方法对2005年9月至2006年10月我中心收治的156例未婚的精索静脉曲张(VC)患者行腹腔镜双侧精索静脉高位结扎术,随机分为两组,A组81例采用常规三孔法,B组75例采用经脐三孔法,所有患者术前均经腹部彩超及查体证实为VC,并排除继发性VC。术前记录患者VC程度,精液质量并记录手术时间、术中出血量、手术并发症、术后住院天数等指标。术后1、3、6个月分别随访1次,观察精液质量、手术并发症、症状改善情况及患者满意程度等指标。结果两组术中出血量、手术并发症、术后住院天数无显著差异,手术时间A组为22～42 min(平均32±4.6min),B组为35～50 min(平均42±5.3 min),两者相比有显著差异,经脐三孔法组手术时间比常规三孔法手术时间稍长,术后第1、3、6个月随访,均无复发病例。术后随访两组的精液质量的改善,症状改善情况无明显差异。结论经脐三孔法在腹腔镜精索静脉高位结扎术能达到常规腹腔镜精索静脉高位结扎的效果,其具有伤口更小,腹部无瘢痕,尤其适合某些对身体外观有特殊需求的患者。

Objective To study the application and clinical significance of the new laparoscopic varicocelectomy - umbilical three spots technique(LVL - UTST).Methods From Sep 2005 to Oct 2006,156 cases of varicocele(VC) patients underwent LVL - UTST.These cases were randomized divided into 2 groups,81 cases(group A) underwent conventional laparoscopic varicocelectomy,and 75 cases(group B) underwent LVL - UTST.All these cases were diagnosed as VC by physical and Beta - ultrasound exams,and patients of secondary VC was excluded.The degree of VC,quality of semen,the operation time,blood loss during operation, complications and hospital stay were recorded.During the follow - up at 1,3 and 6 months postoperatively, the symptoms,complications and quality of semen were recorded.Results All the operations were successful, no case converted to open surgery.There was no significant difference in the degree of VC,quality of semen, blood loss during operation,complications and hospital stay.There was significant difference in the oper- ation time between these 2 groups.The operation time of group A was 22～42min(mean 32±4.6min),and group B was 35～50rnin(mean 42±5.4min).No recurrence was found during the 6 months follow - up. There was no significant difference in improvement of symptoms and semen quality between these 2 groups. Conclusions Compared to the conventional LVL,LVL - UTST was less minimal wounds and scarrings,less postoperative pain,and more rapid recovery.It is very useful for some people who has special demand.