腹腔镜Palomo手术治疗青少年精索静脉曲张112例

Clinical and follow-up observation of Laparoscopic Palomo aricocelectomy in treatment of 112 varicoceles in adolescents

目的探讨腹腔镜下Palomo手术治疗青少年精索静脉曲张的临床疗效。方法总结本院2001年7月至2014年3月，采用腹腔镜Palomo手术治疗，并具有术前、术后3、6、12个月完整B超随访资料的112例精索静脉曲张青少年患儿临床资料。结果共112例患儿，均为左侧，年龄11岁至16岁6个月，中位年龄14岁3个月，年龄≥12岁108例，占96．4％。病史最长3年，平均1．3年。患儿治疗前均行阴囊彩色超声检查确诊，并根据B超测量结果计算睾丸体积。112例中，Ⅱ度25例，Ⅲ度87例，全部在腔镜下完成Palomo手术，手术时间20-35min，平均27min。无术后出血、阴囊水肿，平均住院时间5d。112例均完成术后3、6、12个月随访，并复查B超，无一例复发，发现鞘膜积液6例，附睾囊肿1例。Ⅱ度25例中，术前左右睾丸体积差异在10％-15％者11例（44％）；体积差异〉15％共4例（16％）。Ⅲ度87例，术前左右睾丸体积差异在10％-15％者48例（55．2％）；体积差异〉15％共18例（20．6％）。术后112例中，96例（85．7％）患侧睾丸存在显著的“追赶”生长。术后12个月，Ⅱ度25例中，左右睾丸体积差异在10％-15％者4例（16％），〉15％共2例（8％）；Ⅲ度87例中，左右睾丸体积差异在10％-15％者18例（20．6％），〉15％者8例（9．1％），手术后睾丸体积差异明显缩小（P〈0．01）。结论青少年Ⅱ、Ⅲ度精索静脉曲张已经存在两侧睾丸差异性生长，随着临床分度的增加，差异越发显著。Palomo手术后可观察到患侧睾丸显著的“追赶”性生长，左右睾丸体积差异明显缩小。腹腔镜palomo手术具有复发率低，睾丸萎缩可能小等特点，是一种安全可靠的手术方法。

Objetive To explore the clinical effect of Laparoscopic Palomo aricocelectomy treatment for varicoceles in adolescents. Methods Summarize the clinical data of 112 cases who treated by Laparoscopic Palomo aricocelectomy in our Department of Pediatric Surgery from July 2001 to March 2014 and had got the complete follow-up visit data about Bultrasonography before operation and after operation 3 months,6 months, and 12 months. Results 112 cases were all on the left side,and their ages were from ten to sixteen and a half years old; the median age was 14 and 3 months years old. There were 108 cases＇ ages greater than or equal to 12 years old and accounted for 96.4 percent. The longest medical history was 3 years ,and on average it was 1.3 years. Children would be done with all lines of scrotal color ultrasound diagnosis before treatment, and be calculated the volume of the testis according to the results of the B-ultrasonography measurement. Among the 112 cases,25 cases were Ⅱ degree, and the other cases were Ⅲ degree. All cases were completed in Laparoscopic Palomo aricocelectomy; the operation time was between 20 and 35 minutes, and the average time was 27 minute. There was no postoperative bleeding, scrotal edema, and the average hospital stay was 5 days. All of them was completed postoperative 3,6 ,and 12 months follow-up visit data of Bultrasonography; we found 6 cases of hydrocele, 1 case of epididymal cyst. None of the varicocele was relapsed. Out of 25 cases of Ⅱ degree, before operation the volume difference of testis on right and left sides from 10% to 15% accounted for 11 cases （44%） and the volume difference over 15% were 4 cases （16%）. Out of 87 cases of Ⅲ degree,before operation the volume difference of testis on both sides from 10% to 15% accounted for 48 cases （55.2%） and the volume difference of testis over 15% were 18 cases （20.6%）. Out of 112 cases,there were 96 cases （85.7%） that children＇s affected side testis showed a significant catch-up growth after operation. At 12 months postoperatively, among the 25 cases of 11 degree varicoceles, there were 4 cases （ 16% ） had preoperative difference of testicular volume between 10% and 15% ,and 2 cases （8%） was over 15% ;among the 87 cases of Ⅲ degree varicoceles,there were 18 cases （20.6%） had preoperative difference of testicular volume between 10% and 15 %, and 9 cases （9.1%） was over 15 %. The difference of testicular volume reduced obviously after the operation （P 〈0.01 ）. Conclusions 1. The adolescents patients who had Ⅱ or Ⅲ degree varicocele have had different development of bilateral testicle, and with the increasing of clinical divisions ,the difference becomes more and more obvious. 2. The affected testicle shows a significant catch-up growth, and the difference of bilateral testicular volume was narrowed obviously after the Laparoscopic Palomo aricocelectomy. 3. The Laparoscopic Palomo aricocelectomy is a safe and reliable method to varicocele.