微通道腹腔镜技术在青少年精索静脉曲张手术中的应用

Application of small incision access laparoscopy in adolescent varicocelectomy

目的探讨微通道腹腔镜高选择性精索静脉结扎术治疗青少年精索静脉曲张的临床疗效。方法回顾本院47例青少年精索静脉曲张患者,28例行微通道腹腔镜高选择性精索静脉高位结扎术,19例行显微镜经腹膜后精索静脉结扎术。术后随访6~12个月,比较手术情况、有效性、安全性、恢复情况及医疗费用等。结果两组均顺利完成手术,无严重并发症。腹腔镜组患者手术时间更短,切口更小,疼痛评分更低,术后恢复快,切口美容评分更高,差异均有统计学意义(均P<0.05);显微镜组住院费用更低(P<0.05);两组均能明显缓解阴囊胀痛、均无阴囊水肿和睾丸萎缩,复发率差异无统计学意义。结论微通道腹腔镜高选择性精索静脉高位结扎术治疗青少年精索静脉曲张安全、有效,且手术时间短,疼痛轻,疤痕小,适合临床推广应用,可作为青少年精索静脉曲张的首选术式。

Objective To evaluate the clinical effect of highly selective laparoscopic varicocelectomy (SHLV) through small incision access in the treatment of adolescent varicocele. Methods 47 adolescent patients who underwent varicocelectomy at our institution were analyzed. Among which, 28 patients underwent SHLV (SHLV group), and 19 received microscopic retroperitoneal varicocelectomy (MRV group). The clinical data were compared. Results Both groups underwent varicocelectomy successfully, with no serious complication The operation time was significantly shorter, the incision was smaller, the pain score was lower, and the incision cosmetic score was higher in the SHLV group than in the MRV group, with statistical differences (all P < 0.05). The medical cost was much lower in the MRV group than in the SHLV group, with a statistical difference. No scrotum edema and testicular atrophy occurred in both group. There was no statistical difference in recurrence rate between the two groups. Conclusion SHLV is safe and effective, suitable for clinical application. We suggest that SHLV can be the first choice for adolescent varicocele.