微通道腹腔镜高选择性双侧精索静脉结扎术的临床应用价值

Application value of small incision access highly selective laparoscopic bilateral varicocelectomy

目的探讨微通道腹腔镜高选择性精索静脉结扎术治疗双侧精索静脉曲张的临床应用价值。方法回顾性分析中山大学附属东华医院74例双侧精索静脉曲张患者的临床资料,其中42例行微通道腹腔镜高选择性双侧精索静脉结扎术,32例行显微镜经外环口双侧精索静脉结扎术。术后随访6~12个月,比较不同术式间手术情况、有效性、安全性及医疗费用等的差异。结果腹腔镜组手术时间更短,切口更小,疼痛评分更低,切口美容评分更高,差异均有统计学意义(P<0.05);显微镜组住院费用更低(P<0.05);两组在缓解阴囊胀痛和改善精液质量方面均有较好效果,差异无统计学意义(P>0.05),术后6个月曲张复发率无明显差异(P>0.05)。结论微通道腹腔镜高选择性精索静脉结扎术安全、有效,且手术时间短、疼痛轻、疤痕小,值得临床推广应用,可作为双侧精索静脉曲张患者的可选术式。

Objective To evaluate the application value of small incision access highly selective laparoscopic varicocelectomy in the treatment of bilateral varicocele.Method The clinical data of 74 patients who underwent surgical correction of varicocele in our institution were retrospectively analyzed.The patients were divided into small incision access highly selective laparoscopic varicocelectomy group(SHLV group,n=42),and microscopic subinguinal varicocelectomy group(MSV group,n=32).All patients were followed up for 6-12 months.The operation outcomes,effectiveness,safety,medical costs and other parameters were compared between the two groups.Result Compared with the MSV group,the SHLV group had significantly shorter operation time,smaller incision,lower pain score,higher incision cosmetic score,but higher medical costs(all P<0.05).There were no significant differences in the improvement of scrotum swelling pain,semen quality,and 6-month recurrence rate between the two groups(all P>0.05).Conclusion SHLV is safe and effective in the treatment of varicocele,with advantages of short operation time,bearable pain and small scar.It is worth of clinical promotion and can be an alternative treatment for bilateral varicocele.