精索静脉曲张5种术式的疗效及并发症的对比观察

发布时间：2018-05-28 17:11

本文选题：精索静脉曲张 + 显微外科　；参考：《中华男科学杂志》2015年09期

【摘要】：目的:比较显微镜下腹股沟径路、腹腔镜经腹径路、腹腔镜腹膜外径路、传统开放精索静脉高位结扎术和逆行介入栓塞术5种精索静脉曲张手术治疗精索静脉曲张的疗效及并发症。方法:回顾分析632例精索静脉曲张患者,按不同手术方式共有5组:显微镜下精索静脉结扎术组(79例)、腹腔镜经腹径路组(120例)、腹腔镜腹膜外径路(137例)、传统精索静脉高位开放手术组(283例)、介入栓塞组(13例),比较术前、术后3个月的精液质量、术后并发症,以及术后配偶妊娠率。结果:显微镜组和介入栓塞组手术时间最长[(2.02±1.25)h和(2.17±1.02)h];介入栓塞术组术后住院天数最短,仅(1.1±0.1)d;术中并发症(出血、肠道损伤等)腹腔镜经腹径路组2例,介入栓塞组有1例。术后阴囊水肿发生率介入栓塞组为0,显微镜组、腹腔镜经腹径路、腹腔镜腹膜外径路组、传统高位开放手术组分别为3.7%、17%、10%、19%;术后1年复发率显微镜组最低(1.6%),而介入栓塞组最高(22%)。各组术后精子浓度、前向运动(PR)精子百分率、正常形态精子百分率均较术前明显提高(P0.05),但各组间无统计学差异。配偶妊娠率各组无明显差异(P0.05)。结论:在目前5种精索静脉曲张手术方式中,腹腔镜腹膜外径路手术时间短,并发症少,适宜手术量大的男科应用;显微外科精索静脉结扎术创伤小、恢复快、术后并发症少、复发率最低,是今后的发展方向,但手术时间相对较长,需要专门显微镜和显微外科培训。介入栓塞术可局部麻醉下进行,无手术刀疤,术后恢复最快。
[Abstract]:Objective: to compare the microscopical inguinal approach, laparoscopic transabdominal approach and laparoscopic external peritoneal approach. Effects and complications of traditional open varicocele ligation and retrograde interventional embolization in the treatment of varicocele. Methods: 632 patients with varicocele were retrospectively analyzed. According to different operation methods, there were 5 groups: 79 cases of spermatic vein ligation under microscope, 120 cases of laparoscopy via abdominal approach, 137 cases of laparoscopic external peritoneal diameter, 283 cases of traditional varicocele vein high opening operation group, and interventional embolization group. 13 cases were compared before operation. Semen quality, postoperative complications, and pregnancy rate of spouses 3 months after operation. Results: the operation time was the longest in microscope group and interventional embolization group [2.02 卤1.25h and 2.17 卤1.02h], the duration of hospitalization in interventional embolization group was the shortest (1.1 卤0.1 days), the complications (bleeding, intestinal injury, etc.) in laparoscopic transabdominal approach group (2 cases), interventional embolization group (1 case). The incidence of scrotal edema was 0 in the interventional embolization group, 3.717 in the conventional high open operation group, 3.717 in the microscope group, 3.717 in the laparoscopic external peritoneal approach, and 1.6 in the microscope group, and the highest in the interventional embolization group. After operation, the sperm concentration, the percentage of forward motility (PRP) and the percentage of normal spermatozoa were significantly increased in each group as compared with those before operation, but there was no statistical difference among the groups. There was no significant difference in spousal pregnancy rate in each group (P 0.05). Conclusion: among the five kinds of varicocele operation, laparoscopic external peritoneal approach has the advantages of short operation time, less complications and suitable for large amount of operation, microsurgical varicocele ligation has less trauma, quick recovery and less postoperative complications. The recurrence rate is the lowest, which is the development direction in the future, but the operation time is relatively long, which requires special training in microscope and microsurgery. Interventional embolization can be performed under local anesthesia, no surgical scar, the fastest postoperative recovery.
【作者单位】：南京大学医学院附属鼓楼医院男科;
【基金】：国家自然科学基金(81270694) 南京市青年卫生人才项目(宁卫科[2011]32号)资助项目~~
【分类号】：R699.8

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