经脐双通道腹腔镜与显微镜治疗双侧精索静脉曲张的疗效比较

Comparison of efficacy between transumbilical two-channel laparoscopic andmicroscopic treatment of bilateral varicocele

目的对比分析经脐双通道腹腔镜双侧精索静脉结扎术与外环下显微镜双侧精索静脉结扎术的临床疗效。方法回顾性分析45例经脐双通道腹腔镜双侧精索静脉结扎术及37例外环下显微镜双侧精索静脉结扎术患者的临床资料。比较2组患者术前、术后3个月的精液质量变化、术中出血量、手术时间、术后并发症(阴囊及皮下血肿、疤痕增生、精索静脉曲张复发)以及配偶妊娠率等情况。结果经脐双通道腹腔镜组平均手术时间较显微镜组显著缩短[(38.20±10.23)min vs.(80.46±15.72)min,P<0.05]。2组术中出血量、阴囊及皮下血肿、术口疤痕增生发生率差异无统计学意义(P>0.05)。术后随访3~36个月,随访期间2组复发率及配偶妊娠率差异无统计学意义(P>0.05)。经脐双通道腹腔镜组与显微镜组组内比较术后3个月精液质量相关参数均较术前有显著改善(P<0.05),但是术后3个月2组的精液质量相关参数组间差异无统计学意义(P>0.05)。结论与显微镜双侧精索静脉结扎术相比,经脐双通道腹腔镜下双侧精索静脉高位结扎术具有手术时间短、美容效果佳、术后恢复快、安全有效等优点,具有一定的临床推广价值。

Objective To compare the clinical efficacy of transumbilical two-channel laparoscopic and microscopic bilateral ligation of spermatic vein in the treatment of bilateral varicocele.Methods The clinical data of 45 cases of bilateral spermatic vein ligation by transumbilical two-channel laparoscope(two-channel group)and37 cases of bilateral spermatic vein ligation by circumferential microscope(microscope group)were retrospectively analyzed.The changes of semen quality before operation and 3 months after operation,intraoperative blood loss,operation time,postoperative complications and spouse pregnancy rate were compared between the two groups.Results The mean operating time[(38.20±10.23)]min in the two channel group was significantly shorter than that in the microscope group[(80.46±15.72)min](P<0.05),There was no significant difference in intraoperative blood loss between the two groups(P>0.05).There was no significant difference in the incidence of scrotal and subcutaneous hematoma and intraoperative scar hyperplasia between the two groups(P>0.05).Postoperative follow-up of 3~36 months showed no significant difference in recurrence rate and spouse pregnancy rate between the two groups(P>0.05).The relative parameters of semen quality in the two-channel group and the microscope group3 months after operation were significantly improved compared with that before operation(P<0.05),but there was no significant difference between the two groups 3 months after operation(P>0.05).Conclusion Compared with bilateral spermatic vein ligation under microscope,ligation of bilateral spermatic vein under transumbilical two-channel laparoscope has advantages of shorter operation time,better cosmetic effects,and faster postoperative recovery.It is worth of clinical promotion.