【www.zhangdahai.com--领导讲话稿】
【摘要】 目的 分析精索静脉高位结扎的两种手术方式,总结精索静脉曲张患者的术后疗效。方法 采用开放性精索静脉高位结扎术76例,腹腔镜精索静脉高位结扎术78例,术后随访6个月。结果 两组在手术时间上无明显差异。腹腔镜组术后住院时间明显短于开放手术组。两组患者术后症状改善,随访无复发和睾丸萎缩。结论 腹腔镜精索静脉高位结扎术治疗精索静脉曲张,创伤小,恢复快,是一种安全可靠的手术方法,可作为手术治疗精索静脉曲张的首选。
【关键词】精索静脉曲张;精索静脉高位结扎;腹腔镜
【Abstract】 Objective To analyze varicocele ligation of the two surgical methods of varicocecle patients concluded.Methods Chose open operation in 76 cases and compared with Laparoscopic high ligation of spermatic vein was performed in 78 cases.The patients were followed-up for 6 months.Results There was no significant difference in operation time between two routes of operation.But the duration of postoperative hospital stay in laparoscopic group was much shorter than that group open operation .All patients recovered rapidly after operation,no recurrence and atrophy of testis OCcurred during follow-up.Conclusion Laparoscopic high ligation of spermatic vein has the advantages of short operative time,less inj ury,quicker rehabilitation and simultaneous treatment of bilateral lesions It is a safe and reliable operation method that can be regarded as the first method for treatment of varicocele.
【Key words】Varicocele;Spermatic vein high ligation; Laparoscopic
作者单位:262700山东省寿光市人民医院泌尿外科
2005年1月至2009年5月,本院应用开放性及腹腔镜精索静脉高位结扎术治疗精索静脉曲张154例,并对其疗效进行临床对比,现报道如下。
1 临床资料
1.1 一般资料 精索静脉曲张患者154例,均有不同程度的阴囊坠胀、不适。年龄15~49岁,平均年龄30岁。开放性手术组76例,其中重度52例,中度21例,单侧62例,双侧14例;腹腔镜组78例,其中重度48例,中度25例,单侧病变56例,双侧病变22例。查体中、重度均可及阴囊内蚯蚓状精索静脉丛。
1.2 手术方法
1.2.1 开放手术组 于腹股沟韧带中点上方约2 cm处平行于腹股沟韧方向做一斜切口,逐层切开达精索。仔细将输精管及相伴行的输精管动、静脉分开,在内环口及以上水平集束结扎精索血管,并剪去远端4~5 cm,将已结扎的精索血管两断端再缝扎在一起。
1.2.2 腹腔镜组气管插管全身麻醉,适当头低脚高位,于脐下缘切开约1.0 cm切口,插入气腹针形成气腹后,插入10 mm 的Trocar,注入CO维持气腹压力1.8~2.0 kPa,经此Trocar放人腹腔镜,观察腹腔内情况,然后在右侧麦氏点及左侧相对应位置分别作5 mm切口,在监视器直视下插入相应口径的Trocar,分别置人相应的腔内操作器械,在可视高位处切开后腹膜,分离曲张之精索静脉,牵拉患侧睾丸证实后,4号丝线结扎2道,后期手术我们保护睾丸动脉,双侧病变者可同法结扎对侧静脉,检查术野无出血,拔出Trocar,排尽CO2,缝合切口,外敷创可贴。
2 结果
开放手术组手术时间31~45 min,平均39 min;腹腔镜组手术时间20~75 min,平均35 min,3例术后出现阴囊气肿,均未处理自行消失;两组均术中基本无出血。比较差异无显著性意义(P>0.05)。开放手术组患者术后住院时间7~9 d,平均7.5 d,腹腔镜组术后住院时间3~6 d,平均4.1 d,两组比较差异有显著性意义(P
