腹腔镜手术治疗精索静脉曲张169例临床总结

Laparoscopic varicocelectomy for the treatment of varicocele:report of 169 cases

目的总结腹腔镜手术治疗精索静脉曲张经验。方法2001年3月～2005年12月,实施腹腔镜下精索静脉高位结扎术169例,其中静脉曲张位于左侧151例,右侧6例,双侧12例;采用经腹腔途径手术133例,经腹膜后途径36例,对手术操作要点、成功率及并发症等方面进行总结和分析。结果除1例经腹膜后途径因未找到曲张静脉而改开放手术外,其余均顺利完成。平均手术时间33.2min,平均术后肠功能恢复时间14.6h,平均术后住院天数4.1d,两种途径无明显区别。术后25例(14.9%)出现同侧阴囊气肿,2例(1.2%)仍有明显静脉曲张。106例随访3～48个月,5例(4.7%)复发,其余获成功,成功率为95.3%。3例(2.8%)出现同侧睾丸鞘膜积液。14例不育者中,10例(71.4%)术后精液复查示有明显改善。结论腹腔镜手术是治疗精索静脉曲张的有效方法;经腹腔与经腹膜后两种途径各有其优缺点。经腹腔途径技术容易掌握,适应于双侧病变、肥胖者及有腹膜后纤维化患者;而经腹膜后途径不干扰腹腔,但对术者技术要求较高,适合盆腔粘连及开放或经腹腔手术失败者。

[Objective] To evaluate the outcomes of laparoscopic varicocelectomy for the treatment of varicocele. [Methods] The records of 169 patients （range 13 to 47 years, mean age 26.9） who underwent laparoscopic varicocelectomy from March 2001 through December 2005 were reviewed retrospectively. The varicocele was located on the left side in 151 cases, on the fight in 6, and was bilateral in 12. Among them, 133 were performed tmnsperitoneo- scopicly and 36 retroperitoneoscopicly. The effectiveness, morbidity, and technical ease of the two approaches were documented and summarized. [Results] All operations but 1 were performed successfully. Average operating time, bowel recovery time and postoperative hospital stay was 33.2 minutes, 14.6 hours and 4.1 days respectively. After operation, 25 patients （14.9%） developed scrota] emphysemas and 2 （1.2%） had persistent varlcocele. In 106 cases that were followed for 3-48 months, varlcocele recurred in 5 （4.7%）, testicular hydrocele formation of the affected side occurred in 3 patients （2.8%）, and no ipsilateral testicular atrophy developed in any patient. In 14 previously infertile patients, 10 （71.4%） had obvious improvement in sperm counts and motilities. [Conclusions] Both transperltoneoscopic and retroperitoneoscopic varicocelectomy are effective and safe methods for the treatment of varicocele. Each of them has its advantages and disadvantages and unique indications under some special circumstances.