经腹膜外途径腹腔镜下治疗双侧精索静脉曲张临床疗效分析

Laparoscopic extraperitoneal high ligation of the spermatic vein for the treatment of varicocele

目的:观察经腹膜外途径腹腔镜下治疗双侧精索静脉曲张高位结扎的疗效。方法:回顾性分析48例经腹膜外途经腹腔镜下精索静脉高位结扎术及32例经腹腔途经腹腔镜下精索静脉高位结扎术患者。比较两组患者术前、术后l、3、6个月的精液质量变化情况,两组患者术中出血量、手术时间、术后胃肠功能恢复时间、术后并发症(皮下血肿、阴囊及皮下气肿、精索静脉曲张复发)以及配偶妊娠率等情况。结果:经腹膜外组和经腹腔组术后精液质量参数均较术前有明显改善(P<0.05),但是术后1、3、6个月的精液质量参数比较无统计学差异(P>0.05);两组术中出血量、手术时间[(38.27±9.23)min vs(43.46±11.72)min],无明显差异(P>0.05),而胃肠道恢复时间经腹膜外途径组[(1.27±0.26)d]明显短于经腹腔途径组[(2.43±0.41)d,P<0.05]。术后随访6~18个月,两组皮下血肿、阴囊及皮下气肿、复发率及配偶妊娠率无统计学差异(P>0.05)。结论:经腹膜外途径腹腔镜下精索静脉高位结扎术具有恢复快、安全有效等优点,具有一定临床推广价值。

Objective ： To investigate the effect of laparoscopic extraperitoneal （LSEP） high ligation of the spermatic vein in the treatment of varicocele. Methods ： We retrospectively analyzed the clinical data about 80 cases of varieocele, 48 treated by LSEP and the other 32 by laparoscopic transabdominal retroperitoneal （LSTR） high ligation of the spermatic vein. We recorded the semen parameters before and at 1, 3 and 6 months after surgery, intraoperative blood loss, operation time, postoperative complications, time of gastrointestinal function recovery and rate of pregnancy, followed by comparison of the data obtained between the two groups of pa- tients. Results ： Semen parameters were remarkably improved in both the LSEP and LSTR groups of patients postoperatively as com- pared with the baseline （P 〈 0.05）, but with no statistically significant difference at different postoperative months （ P 〉 0.05）. The intraoperative blood loss was less in the LSEP than in the LSTR group （ [ 8.3 ± 5.2 ] vs [ 9.1 ± 6.1 ] ml, P 〉 0.05 ）, the operation time was shorter in the former than in the latter （ [ 38.27± 9.23 ] vs [43.46 ± 11.72 ] min, P 〉 0.05 ）, and so was the time of gastrointestinal function recovery （ [ 1.27 ± 0.26 ] vs [ 2.43 ± 0.41 ] d, P 〈 0.05）. No statistically significant differences were ob-served between the two groups during the 6- to 18-month follow-up in the rates of postoperative subcutaneous hematoma, scrotal and subcutaneous emphysema, recurrence, or pregnancy （ P 〉 O. 05 ）. Conclusion ： Laparoscopic extraperitoneal high ligation of the spermatic vein is safe and effective and has the advantage of quick recovery in the treatment of varicocele.