原位纵向分离法改良与传统Palomo术治疗精索静脉曲张的临床研究

Orthotopic dissection modified Palomo surgery vs classical Palomo surgery in treatment of varicocele:A clinical study

目的:比较原位纵向分离法改良Palomo术与传统Palomo术治疗精索静脉曲张的疗效。方法:回顾性分析2015年7月至2017年1月东莞市第三人民医院与东莞常安医院收治的112例精索静脉曲张患者的临床资料,根据术式不同分为改良组(原位纵向分离法改良Palomo术,57例)和传统组(传统Palomo术,55例),比较两组手术时间、术中出血量、精液改善率、鞘膜积液和阴囊水肿发生率率、睾丸萎缩率、术后复发率等指标。结果:改良组手术时间[(36.5±5.7)min vs(28.1±4.9)min,t=8.350,P=0.000]、术中出血量[(1.81±0.63)mL vs(1.32±0.22)mL,χ~2=5.455,P=0.000]、精液改善率(87.72%vs69.09%,χ~2=5.769,P=0.016)高于传统组;鞘膜积液和阴囊水肿发生率(3.51%vs 20.00%,χ~2=7.420,P=0.007)低于传统组。两组患者睾丸萎缩率(0 vs 0,χ~2=0.000,P=1.000)、术后复发率(3.51%vs 1.82%,χ~2=0.307,P=0.580)比较,差异无统计学意义。结论:原位纵向分离法改良Palomo术治疗精索静脉曲张疗效确切,具有手术创伤小、较快改善精液质量等优点,值得临床广泛推广。

Objective:To compare the efficacy of orthotopic dissection modified Palomo surgery vs classical Palomo surgery in the treatment of varicocele.Methods:The clinical data of 112 patients with varicocele admitted to Dongguan Third Municipal People ’s Hospital and Dongguan Chang ’an Hospital between July 2015 and January 2017 were retrospectively analyzed.According to different surgical methods,all patients were divided into the modified group(orthotopic dissection modified Palomo surgery,n=57) and the classical group(classical Palomo surgery,n=55).The operative time,intraoperative blood loss,semen improvement rate,incidence of hydrocele and scrotal edema,testicular atrophy rate,and postoperative recurrence rate were compared between the two groups.Results:The operative time [(36.5±5.7) min vs(28.1 ± 4.9) min,t=8.350,P=0.0000 ],intraoperative blood loss [(1.18±0.63) ml vs(1.32±0.22) ml,χ~2=5.455,P=0.000] and semen improvement rate(87.72% vs 69.09%,χ~2=5.7692,P=0.016) in the modified group were significantly higher than those in the classical group,whereas the incidence of hydrocele and scrotal edema(3.51% vs 20.00%,χ~2=7.420,P=0.007) were significantly lower than those in the classical group.There were no statistically significant differences in the testicular atrophy rate(0% vs 0%,χ~2=0.000,P=1.000) and postoperative recurrence rate(3.51% vs1.82%,χ~2=0.307.P=0.580) between the modified group and traditional group.Conclusion:Orthotopic dissection modified Palomo surgery for the treatment of varicocele offers definite therapeutic efficacy,less surgical trauma,and quick improvement of semen quality,which justifies its widespread use in clinical practice.