通过术中注射亚甲蓝行保留淋巴管的腹腔镜精索静脉高位结扎术的临床研究

A Clinical Study of Laparoscopic lymphatic Sparing Varicocelectomy Using Methylene Blue

目的探讨通过术中睾丸白膜内注射亚甲蓝,行保留淋巴管的腹腔镜精索静脉高位结扎术的安全性及有效性。方法对本单位收治的33例精索静脉曲张患者,行腹腔镜精索静脉高位结扎术,术中通过睾丸白膜内注射亚甲蓝显示淋巴管,并予分离后保留。结果本组33例患者均成功进行保留淋巴管的腹腔镜精索静脉高位结扎术,平均手术时间30分钟(20~45分钟),术后无明显并发症,住院时间5~7天。术后患者术后1个月、3个月及6个月门诊复诊,平均随访4个月(3~6个月),术后1~3个月患者症状逐渐消失,未发现阴囊淋巴水肿及睾丸鞘膜积液病例。结论通过术中睾丸白膜内注射亚甲蓝,显示精索内淋巴管确切,保留淋巴管的腹腔镜精索静脉高位结扎术治疗效果确凿,操作方便,安全有效。

Objective To investigate the safety and effectiveness of laparoscopic lymphatic sparing varicocelectomy using methylene blue. Methods 33 patients underwent lpaparoscopic lymphatic sparing varicocelectomy,and a classical methylene blue intra-dartos/intra-testicular injection. Then the lymphatic vessels were clearly demonstrated,separated and preserved. Results All patients underwent laparoscopic lymphatic sparing varicocelectomy were successful,with average operation time of 30 minutes（ ranged from 20 to 45 minutes）. There was no obvious complications after the laparoscopic lymphatic sparing varicocelectomy and the hospital stay was5 ~ 7 days. The follow up time was 1,3 and 6 months postoperatively. The average follow-up time was 4 months（ ranged from 3 to 6 months）,and the symptoms disappeared gradually 1 ~ 3 months postoperatively. No scrotal lymph node swelling or hydrocele case was found. Conclusions It is a safe and effective method to preserve spermatic lymphatic vessels by injecting methylene blue in the laparoscopic varicocelectomy and the spermatic lymphatic vessels were shown clearly.