腹腔镜下保留睾丸动脉的精索静脉高位结扎术技巧探讨

Technique of the testicular artery-preserving laparoscopic high ligation of spermatic vein

目的探讨腹腔镜下保留睾丸动脉的精索静脉高位结扎术治疗精索静脉曲张(VC)的手术技巧。方法选择86例VC患者,行腹腔镜下保留睾丸动脉的精索静脉高位结扎术,总结分析腹腔镜下保留睾丸动脉的精索静脉高位结扎术手术要点和经验体会。结果86例VC患者的腹腔镜下保留睾丸动脉的精索静脉高位结扎术均顺利完成,无中转开放手术或改变手术方式者,手术时间为58(36,86)min。术后阴囊少量气肿2例,睾丸少量积液2例。所有患者在术后3个月复查彩色多普勒超声均未见积液,VC复发6例(7%)。与术前相比,术后3个月患者的VC程度减轻、精子密度及活力(A+B级)改善,有阴囊疼痛坠胀等症状者比例降低(P均<0.05)。不育症患者配偶术后1年的自然妊娠率为38%(6/16)。未见睾丸萎缩病例。结论腹腔镜下保留睾丸动脉的精索静脉高位结扎术可有效治疗VC,辨认及分离睾丸动脉是手术成功的关键。

Objective To investigate the surgical technique of testicular artery-preserving laparoscopic high ligation of spermatic vein( LHLSV). Methods Eighty-six patients with varicocele( VC) undergoing testicular artery-preserving LHLSV in our institution were enrolled in this study. Surgical techniques and experience were discussed. Results The testicular artery-preserving LHLSV was successfully performed in 86 VC patients. No case was switched to open surgery or other surgeries. The mean operation time was 58( 36, 86) min. Postoperatively, 2 cases suffered from mild scrotal emphysema and 2 cases of slight testicular hydrocele. Color Doppler ultrasound at postoperative 3 months demonstrated no effusion in all patients. VC recurred in 6 patients. The severity of VC, sperm density and sperm motility( grade A+B) were significantly improved, and the percentage of patients presenting with scrotal swelling pain was considerably decreased at postoperative 3 months( all P < 0.05). The natural pregnancy rate for the infertile patients was 38%( 6/16) at postoperative 1 year. No testicular atrophy was observed. Conclusions The testicular artery-preserving LHLSV is an efficacious treatment of VC. Identification and isolation of the spermatic artery is the key step of the surgical success.