经脐单孔腹腔镜手术治疗青少年精索静脉曲张12例

Transumbilical Laparoscopic Single-site Varicocelectomy for Adolescents:Report of 12 Cases

目的探讨经脐单孔腹腔镜手术治疗青少年精索静脉曲张的可行性。方法 2009年1月～2011年12月,12例(9～16岁)精索静脉曲张(左侧11例,双侧1例)经脐直视下置入10 mm trocar,置入单孔带操作孔道的直径10 mm腹腔镜,置入剪刀,距内环口5 cm处沿后腹膜表面剪开精索两侧的后腹膜约2 cm,拔出剪刀再置入电钩进一步游离松解精索约2～3cm的长度,经腹壁分次置入2根2-0带针丝线,结扎精索血管束2道。结果 12例经脐单孔腹腔镜手术顺利完成,手术时间25～35 min,平均30 min。术后12 h内观察阴囊,曲张的静脉团块消失。无腹胀,1例偶有轻度腹部切口疼痛,腹部不适2例,未治疗自行缓解。术后2～3 d出院,切口为吸收线缝合不拆线。12例术后随访3～6个月,左侧阴囊部位的静脉团块消失,阴囊下坠感及下腹不适症状消失,脐部切口愈合好,无脐疝发生,3～6个月时脐部未见明显的手术瘢痕。结论经脐单孔腹腔镜手术治疗青少年精索静脉曲张可行,疗效满意,术后腹部无可见瘢痕。

Objective To investigate the feasibility of transumbilical single-site laparoscopic varicocelectomy for adolescents. Methods From January 2009 to December 2011, 12 patients （aged 9 to 16 years） with varicocele （left side in 11 cases, and bilateral in the other） received transumbilical single-site laparoscopic varicoceleetomy in our hospital. Under direct vision, we placed a 10-ram trocar through the umbilicus, and then introduced a single-site laparoscope （ 10-mm in diameter） with a 5-mm port, the spermatic vessels were identified, and then at 5 em away from the inter ring, the retroperitoneal was cut （2 cm） so that to isolate 2- to 3-cm spermatic cord, and then ligate the spermatic vessels with two 2-0 silk sutures. Results The procedure was completed in all the 12 patients within 25 to 35 min （mean, 30 rain）. Twelve hours after the operation, the varicocele disappeared. No patients complained of abdominal distension after the surgery, one patient had mile incisional pain, and two patients had abdominal discomfort, all of them were cured spontaneously. The patients were discharged from hospital in 2 to 3 days, and then were followed up for 3 to 6 months, during which, the umbilical incision was healed well without umbilical hernia occurred. The symptoms and signs of varieocele were all gone. No obvious surgical scars were observed. Conclusion Transumbilieal single-site laparoscopic varicocelectomy is feasible and effective for adolescents without scars left on the abdomen.