显微外科手术与单孔腹腔镜手术治疗精索静脉曲张的临床疗效与安全性对比

Comparison of clinical efficacy and safety of microsurgery and single-port laparoscopic surgery for varicocele

目的探讨显微外科手术与单孔腹腔镜手术治疗精索静脉曲张的临床疗效与安全性。方法收集2019年1月至2021年1月于首都医科大学附属北京天坛医院接受手术治疗的60例精索静脉曲张患者的临床资料,根据手术方式的不同将其分为腔镜组(n=29,采用单孔腹腔镜下精索静脉高位结扎术治疗)和显微组(n=31,采用显微镜下精索静脉高位结扎术治疗)。比较两组患者的临床指标,包括手术用时、术中出血量、术后排气恢复时间、术后下床时间、住院时间。比较两组患者的术后6、12、24 h疼痛程度[视觉模拟评分法(VAS)评分]。比较两组患者术前、术后3 d炎性反应指标,包括C反应蛋白(CRP)、白细胞介素-6(IL-6)、内皮素(ET)水平、白细胞计数。比较两组患者的术后并发症发生率和术后1个月临床疗效指标(活精率、精子活力、精子密度)。比较两组患者术后6个月的复发率。结果显微组患者的手术用时明显长于腔镜组患者,术中出血量明显少于腔镜组患者,术后排气恢复时间、术后下床时间、住院时间均明显短于腔镜组患者,差异均有统计学意义(P<0.01)。术后6、12、24 h,显微组患者的VAS评分均低于腔镜组患者,差异均有统计学意义(P<0.05)。术后3 d,显微组患者的血清CRP、IL-6、ET水平及白细胞计数均低于腔镜组患者,差异均有统计学意义(P<0.05)。显微组患者的术后并发症总发生率低于腔镜组患者,差异有统计学意义(P<0.05)。术后6个月,两组患者的复发率比较,差异无统计学意义(P>0.05)。结论与单孔腹腔镜下精索静脉高位结扎术相比,显微镜下精索静脉高位结扎术治疗精索静脉曲张可获得更好的临床疗效,患者术后疼痛程度与炎性反应程度更轻,术后恢复更快,手术安全性更高。

Objective To investigate the clinical efficacy and safety of microsurgery and single-port laparoscopic surgery for varicocele.Method The clinical data of 60 patients with varicocele who underwent surgical treatment in Beijing Tiantan Hospital,Capital Medical University from January 2019 to January 2021 were collected,they were divided into endoscopic group(n=29,treated by single-port laparoscopic high spermatic vein ligation)and microscopic group(n=31,treated by microscopic high spermatic vein ligation)according to different surgical methods.The clinical indicators,including surgery time,intraoperative blood loss,postoperative exhaust recovery time,postoperative ambulation time,and hospitalization time of the two groups of patients were compared.The pain degree[visual analogue scale(VAS)scores]at 6,12 and 24 h after surgery were compared between the two groups.The inflammatory response indicators,including C-reactive protein(CRP),interleukin-6(IL-6),endothelin(ET)levels,and white blood cell counts before and 3 days after surgery were compared between the two groups of patients.The incidence rate of postoperative complications and clinical efficacy indicators(viable sperm rate,sperm motility,sperm density)at 1 month after surgery were compared between the two groups.The recurrence rate of the two groups at 6 months after surgery were also compared.Result The surgery time of the patients in the microscopic group was significantly longer,the intraoperative blood loss was significantly lower,and the postoperative exhaust recovery time,postoperative ambulation time,and hospitalization time were significantly shorter than those of the endoscopic group,the differences were statistically significant(P<0.01).At 6,12 and 24 h after the surgery,the VAS scores of the microscopic group were lower than those of the endoscopic group,and the differences were statistically significant(P<0.05).Three days after the surgery,the serum CRP,IL-6,ET levels and white blood cell counts of the patients in the microscopic group were lower than those in the endoscopic group,and the differences were statistically significant(P<0.05).The total incidence rate of postoperative complications in the microscopic group was lower than that in the endoscopic group,and the difference was statistically significant(P<0.05).At 6 months after the surgery,there was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion Compared with single-port laparoscopic high spermatic vein ligation in the treatment of varicocele,microscopic high spermatic vein ligation could achieve better clinical efficacy,and the degree of postoperative pain and inflammatory reaction of patients is less,their postoperative recovery is faster,and the surgery safety is higher.