不同术式精索静脉高位结扎术后睾丸鞘膜积液发病率的比较

The incidence of hydrocele after varicocelectomy in a long-term follow-up

目的探讨男性患者采用不同术式行精索静脉高位结扎术后睾丸鞘膜积液的发病率,发病时间,及其与手术术式的相关性。方法总结165例男性精索静脉曲张患者不同术式的182次精索静脉高位结扎术,回顾性分析不同术式睾丸鞘膜积液的发病率。结果患者术后出现了25例次的鞘膜积液。Poloma术后鞘膜积液的发生率为21.2%,Ivanissevich术后鞘膜积液的发生率为13.2%,腹腔镜精索内静脉高位集束结扎的患者术后鞘膜积液的发生率为20.7%,而高位分离结扎的患者术后鞘膜积液的发生率为8.0%;术后6个月内出现鞘膜积液并不常见,大多数出现鞘膜积液的患者都是在手术12个月以后,甚至手术2年以后。结论术中保留淋巴管对于预防术后睾丸鞘膜积液的发生具有重要意义。

Objective Hydrocele is a known complication of varicocelectomy. We evaluated the incidence of hydrocele following different varicocelectomy procedures at our institution. Methods A total of 165 patients were treated with ligation of the spermatic vessels for clinically palpable varicoceles and follow-up for more than 6 months postoperatively. Patient＇ s charts were reviewed for operative technique and complications. Results A total of 25 patients had developed hydrocele postoperatively, all of them required hydrocelectomy. In addition, of the 165 patients with longer than 12 months of follow up 81.8% had development of hydrocele. A less incidence of hydrocele （8.0%） was also noted in patients who underwent laparoscopic varicocelectomy （internal spermatic vein were separated and ligated individually） than that of others. Conclusion There appears to be a statistically significant decrease in hydroceles when the internal spermatic vein are separated and ligated individually than that of cluster ligation. The standard technique of laparoscopic varicocelectomy may decrease hydrocele formation because of salvaging lymphatics.