腹腔镜下Palomo术与改良Palomo术治疗精索静脉曲张的临床对照研究

Clinic contrast studies of laparoscope palomo and improved palomo in the treatment of varicocele

目的探讨腹腔镜下精索静脉结扎治疗精索静脉曲张保留精索动脉的必要性。方法 99例精索静脉曲张患者随机分两组,分别采取腹腔镜下Palomo术式和保留精索动脉的改良Palomo术式治疗,对照分析术后临床资料。结果 Palomo组手术时间平均(22.0±5.3)min,估计出血量平均(4.0±1.4)mL,复发率6.1%;改良Palomo组手术时间平均(35.0±6.5)min,估计出血量平均(8.0±2.3)mL,复发率20.0%,两组比较差异有显著性。Palomo组术后鞘膜积液发生率8.2%,睾丸萎缩发生率8.2%,精液改善比率75.5%;改良Palomo组鞘膜积液发生率6.0%,睾丸萎缩发生率4.0%,精液改善比率86%,两组相比较差异无显著性。结论腹腔镜精索静脉结扎术不必非要保留精索动脉,腹腔镜集束精索治疗精索静脉曲张是一种安全可靠、并发症少的手术方式,明显降低复发率。

[Objective] To study necessity of laparoscopic varicocelectomy in the treatment of varicocele to retain spermatic cord. [Method] 99 patients were divided into two groups in random, who respectively took laparoscope palomo and improved palomo saving spermatic. A cross-check analysis was made with postoperation data. [Result] In laparoscope group, average operative time was （22.0±5.3） min, estimative amount of bleeding was （4.0±1.4） mL, recurrence rate was 6.1%; In the improved group, average operative time was （35.0±6.5） min, estimative amount of bleeding was （8.0±2.3） mL, and recurrence rate was 20.0%. Differences were statistical significance between them. In laparoscope group, incident rate of hydrocele of tunica vaginalis was 10.2%, orchiatrophy was 8.2%, ratio of semen improved was 75.5%; In the improved group, incident rate of hydrocele of tunica vaginalis was 6.0%, orchiatrophy was 4.0%, ratio of semen improved was 86%, there was no statistical significance between them. [Conclusion] There was no necessity to retain spermatic cord in laparoscope palomo. Laparoscope palomo is a safe and reliable treatment for varicocele with less complications and lower recurrent rate.