腹腔镜全腹膜外同期治疗精索静脉曲张合并腹股沟斜疝16例

Simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis and varicocelectomy for patients with varicocele combined with indirect inguinal hernia

目的 初步评价腹腔镜全腹膜外疝修补术（totally extraperitoneal prosthesis,TEP）与TEP入路高位精索静脉结扎术同期治疗精索静脉曲张合并腹股沟斜疝的安全性和有效性.方法 回顾性分析2014年11月至2016年11月在本院行腹腔镜TEP与TEP入路高位静脉结扎治疗16例精索静脉曲张合并腹股沟斜疝的临床资料.术前彩超检查：精索静脉直径为2.1-5.0 mm.记录术中术后的疗效观察指标,包括手术时间、术中出血量、肠蠕动恢复时间、术后镇痛情况、并发症、住院天数、恢复正常活动时间.术后门诊随访3-24个月.结果 本组16例手术均取得成功.手术时间（39.8±7.6）min,术中出血量（6.5±3.2）mL,肠蠕动恢复时间（7.8±0.9）h,一般无术后镇痛,术后住院时间（3.6±0.8）d,恢复正常活动时间（4.9±0.8）d.无手术并发症发生.术后3个月曲张的精索静脉均消失.随访无睾丸萎缩及鞘膜积液发生,精索静脉曲张及腹股沟斜疝均未复发.结论 同期采用腹腔镜下TEP和TEP入路精索静脉高位结扎术治疗精索静脉曲张合并腹股沟斜疝创伤小,术后恢复快,并发症少,安全有效.

Objective To assess the safety and effectiveness of simultaneous laparoscopic herniorrhaphy by totally extraperitoneal prosthesis （TEP）and simultaneous laparoscopic herniorrhaphy and varicocelectomy by high ligation with the route of TEP.Methods Clinical data of 16 patients who suffered from varicocele combined with indirect inguinal hernia,underwent the simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP from November 2013 to November 2016 were retrospectively analyzed.Varicocele was detected by color Doppler ultrasounography with the mean diameter of （3.12 ± 0.53） mm.The intraoperative and postoperative clinical parametes including bleeding volume,recovery time of intestinal peristalsis,use of postoperative analgesia,complication,hospital stay and postoperative recovery time were recorded and analyzed.All patients were followed up for a range of 3 - 24 months.Results The operation was successful in all cases.The operation time was （39.8 ±7.6） min,the intraoperative blood loss was （6.5 ±3.2） mL,and recovery time of intestinal peristalsis was （7.8 ± 0.9） h.There was no need for postoperative analgesia.The postoperative hospital stay was （3.6 ± 0.8） d,and it took （4.9 ± 0.8） d for the patients to go back to their normal activities.The normal diameter （1.71 ± 0.32） mm of spermatic veins and and good testicular blood supply were detected by the ultrasounography befor discharge.No operative complications were observed.Varieocele was disappeared in all patients at 3 months postoperatively.All patients were followed up for 3 to 24 months without testicular atrophy and hydrocele.Recurrence of either varicocele or indirect inguinal hernia was not found during follow-up.Conclusions Simultaneous laparoscopic herniorrhaphy by TEP and varicocelectomy by high ligation with the route of TEP are safe and effective for patients with varicocele combined with indirect inguinal hernia with the advantage of less trauma,faster postoperative recovery,and less complication.