经脐单孔腹腔镜技术在治疗双侧精索静脉曲张中的应用

The application of transumbilica single-port laparoscopic surgery in the treatment of bilateral varicocele

目的探讨经脐单孔腹腔镜精索静脉高位结扎术治疗双侧精索静脉曲张的临床应用价值。方法应用腹腔镜技术对42例双侧精索静脉曲张患者行双侧精索静脉高位结扎术，其中经脐单孔腹腔镜组20例，传统腹腔镜组22例。对比两种手术方式患者术中出血量、保留睾丸动脉情况、手术时间、术后下床活动时间、肠功能恢复时间及患者住院时间等指标；检测患者术前及术后1年的精液质量。分别于术后1、3、6个月和1年对患者进行4次门诊复查，检查切口恢复情况及阴囊、精索、睾丸有无并发症发生，并询问患者阴囊下坠不适等自觉症状的缓解情况。结果两组手术均获成功，无严重并发症发生。经脐单孔腹腔镜组与传统腹腔镜组术中出血量[（5±1）ml和（5±1）ml，t=-0．452，P〉0．05]、手术时间[（41±7）min和（39±3）min，t=0．686，P〉0．05]、术后肠功能恢复时间[（11±1）h和（11±2）h，t=-1．631，P〉0．05]、术后住院时间[（3．1±0．7）d和（3．4＋0．7）d，t=-1．447，P〉0．05]，差异均无统计学意义。术后应用止痛药单孔腹腔镜组1例（5．0％），低于传统腹腔镜组7例（31．8％），差异有统计学意义（X^2=4．886，P〈0．05）。经脐单孔腹腔镜组切口近于“无瘢痕”。所有病例均于术后1年进行切口满意度问卷调查，两组比较差异有统计学意义（X^2=7．636，P〈0．01）。结论单孔腹腔镜下双侧精索静脉高位结扎术手术效果与传统腹腔镜手术相当，但更加微创，美学效果明显，是腹腔镜手术发展的掐璐．

Objective To explore the clinical value of transumbilica single-port laparoscopic surgery in the treatment of bilateral varieocele. Methods From Jan. 2010 to Sep. 2010, 42 patients with bilateral varicocele underwent laparoscopic high ligation of bilateral spermatic vein. Of these patients ,20 were treated with transumbilica single-port laparoseopic surgery,22 with traditional laparoscopic surgery. The two groups of patients were compared for the parameters such as intraoperative blood loss, testicular artery preservation ,operating time, time of activities after surgery, time of intestinal function recovery and hospitalization duration. The semen quality 1 year after the surgery was compared with that before treatment. At the out-patient re-examination at 1,3,6 months and 1 year after the surgery, the incision, scrotum, spermatic cord, testis were checked for possible complications. The relief of diseomfortness in the scrotum was also followed up. Results Both operation procedures were successful, without severe complications. In the single-port laparoscopic surgery produced blood lose （ [ 5 ± 1 ] ml vs. [ 5 ± 1 ] ml, t = - 0. 452, P 〉 0. 05 ）, the operating time （ [ 41 ± 7 ] min vs. [ 39 ± 3 ] rain, t = 0. 686, P 〉 0. 05 ）, postoperative intestinal function recovery time （ [ 11 ± 1 ] h vs. [ 11 ± 2 ] h, t = - 1.631, P 〉 0. 05 ） and postoperative hospital stay （ [ 3.1 ± 0. 7 ] d vs. [ 3.4 ± 0. 7 ] d, t = - 1. 447,P 〉 0. 05 ） which were all comparable to that from conventional laparoscopic surgery. There was significant difference in the population using analgesics, single-port laparoscopic surgery vs. conventional laparoscopic surgery （ 1 ease [ 5. 0% ] vs 7 case [ 31.8 % ]. The difference was statistically significant （X2 =4. 886,P 〈 0. 05）. The single-port laparoscopic surgery produced neglectable scar at the incision. All of the patients were questionaired for their satisfaction with the incision 1 year after the surgery. The difference was statistically significant （X2 = 7. 636, P 〈 0. 01 ） ] Conclusion Single-port laparoseopie high ligation of bilateral spermatic vein produces comparable outcomes to that of conventional laparoscopic surgery, but it is a more microinvasive procedure producing good aesthetic appearance, representing the trend of laparoscopic technique.