超细腹腔镜器械在精索静脉结扎术中保留睾丸动脉的应用价值

Application value of superfine laparoscopic instruments in preserving artery in varicocelectomy

目的:探讨超细腹腔镜在精索静脉结扎术的临床应用价值及保留睾丸动脉的临床意义。方法:回顾性分析南方医科大学第三附属医院324例行手术治疗的精索静脉曲张患者的临床资料,其中105例使用超细腹腔镜器械(超细组),135例使用传统腹腔镜器械(传统组),84例使用显微镜器械(显微镜组)。比较3组患者的手术疗效、术后并发症等。统计学方法采用t检验、卡方检验和Fisher精确检验。结果:324例患者均顺利完成手术,术后随访3~12个月。与传统组比较,超细组的住院时间、出院前视觉模拟评分法(visual analogue scale,VAS)评分较低,精子活力改善更明显,动脉保留率较高,差异均有统计学意义(均P<0.05)。超细组和显微镜组住院时间、精子活力改善方面比较差异均无统计学意义(均P>0.05),超细组出院前VAS评分、动脉保留率均较显微镜组低(均P<0.05)。超细组与传统组、超细组与显微镜组术后复发率、睾丸鞘膜积液出现率、症状缓解情况比较差异均无统计学意义(均P>0.05)。结论:超细腹腔镜精索静脉高位结扎术能够安全有效地结扎精索静脉,保留睾丸动脉,且相关并发症的发生率并未显著上升,创伤小、术后恢复快、术后瘢痕隐匿、症状的改善和精子质量的提高也体现出其一定的优势,临床上可为有美容需求的患者提供一种微创方式的选择。

Objective:To investigate the clinical application value of superfine laparoscopy in varicocelectomy and the clinical significance of preserving testicular artery.Methods:The clinical data of 324 patients with varicocele undergoing surgical treatment in the Third Affiliated Hospital of Southern Medical University were retrospectively an-alyzed,including 105 cases using superfine laparoscopic instruments(superfine group),135 cases using traditional laparoscopic instruments(traditional group),84 cases using microscope instruments(microscope group).The surgi-cal efficacy and postoperative complications of each group were compared.Statistical methods were t test,chi-square test and Fisher exact test.Results:All 324 patients successfully completed the surgery and were followed up for 3 to 12 months after surgery.Compared with the traditional group,the hospitalization time and visual analogue scale(VAS)score before discharge in the superfine group were lower,the improvement in sperm motility was more signifi-cant,and the arterial retention rate was higher than those in the traditional group,all of the differences were signifinant(all P<0.05).There was no significant difference in hospitalization time or improvement of sperm motility between the superfine group and the microscope group(all P>0.05),the VAS score before discharge and the arterial reten-tion rate were lower in the superfine group than those in the microscope group,the differences were significant(all P<0.05).There were no significant differences in postoperative recurrence rate,incidence of testicular hydrocele,and symptom relief between the superfine group and the traditional group,as well as between the superfine group and the microscopic group(all P>0.05).Conclusion:Ultra-fine laparoscopic high-level varicocele ligation is a safe and effec-tive technique for ligating the spermatic vein while preserving the testicular artery.The occurrence of related complica-tions does not significantly increase,and the technique offers smaller trauma,faster recovery,concealed postopera-tive scars,and improvements in symptoms and sperm quality.It also provides a minimally invasive option for patients with cosmetic concerns.