三种精索静脉高位结扎术治疗儿童精索静脉曲张的疗效分析

doi:10.3877/cma.j.issn.1674-3253.2019.02.014

目的

探讨经腹腔、腹膜后、腹股沟三种不同精索静脉结扎手术对儿童精索静脉曲张疗效的影响。

方法

回顾性分析2009年至2017年单中心收治的97例行精索静脉高位结扎手术患儿（0～14岁）的临床资料，并对其随访。根据精索静脉结扎的手术方式分为A组（腹腔镜下精索静脉高位结扎术，30例）、B组（腹膜后高选择性精索静脉高位结扎术，38例）、C组（腹股沟高选择性精索静脉高位结扎术，29例），比较三组患儿手术时间、出血量、术后住院天数、阴囊水肿、睾丸鞘膜积液、复发、睾丸萎缩、阴囊不适改善情况的差别。

结果

A组平均手术时间（63±4）min长于B组（36±2）min，（P<0.001）和C组（45±4）min，（P=0.002）。A组术后平均住院时间（2.40±0.18） d高于B组（1.04±0.18）d，（P<0.001）和C组（1.28±0.22）d，（P<0.001）。三组患者术后均未出现睾丸萎缩。A组阴囊水肿发生率高于C组（χ²=6.15，P=0.015），A组鞘膜积液发生率高于B组（χ²=4.76，P=0.034）和C组（χ²=7.67，P=0.006）。三组复发率、阴囊不适改善率比较差异均无统计学意义。

结论

腹股沟精索高选择性静脉结扎术操作简单、创伤小、恢复快、并发症发生率低。腹腔镜下精索静脉结扎术需注意保护淋巴管，以减少阴囊水肿和鞘膜积液的发生。

关键词: 儿童, 精索静脉曲张, 精索静脉高位结扎术, 腹腔镜

Objective

To access the clinical effect of different approaches of varicocelectomy (laparoscopic palomo, microsurgical palomo and microsurgical ivinissaich) in treatment of children varicocele.

Method

Data of 97 children (0-14 years old) who underwent varicocelectomy in a single center during 2009 to 2017 were retrospectively analysed and the patients were followed-up. According to the approach of varicocelectomy, the patients were divided into group A (laparoscopic Palomo, 30 cases), group B (Palomo with magnifying glass, 38 cases) and group C (Ivinissaich with magnifying glas, 29 cases). Operation time, blood loss, postoperative length of hospital stay (LOS), rates of scrotal edema, hydrocele, recurrence, orchiatrophy and scrotum discomfort improvement were compared between the three groups.

Results

The average operation time of group A (63±4) min was longer than group B (36±2) min, (P<0.001) and group C (45±4) min, (P=3.54). The average postoperative LOS of group A (2.40±0.18) d was higher than group B (1.04±0.18) d, (P<1.04) and group C (1.28±0.22) d, (P<0.001). No orchiatrophy occurred in the three groups. Scrotal edema rate of Group A was higher than group C (χ²=6.15, P=6.15). Hydrocele rate of group A was higher than group B (χ²=4.76, P=4.76) and group C (χ²=7.67, P=7.67). There were no statistical differences in terms of rates of recurrence and scrotum discomfort improvement between the three groups.

Conclusions

Palomo varicocelectomy has advantages of less-injury, quick recovery and low complication incidence. Laparoscopic varicocelectomy should protect lymphatic vessels to reduce hydrocele.

Key words: Children, Varicocele, Varicocelectomy, Laparoscopic

表1 三组患者术前基本资料的比较

?	例数	年龄（岁）	曲张程度（Ⅱ/Ⅲ，例）	左肾静脉压迫综合征（例）	其他合并症（例）
A组	30	11.8±1.2	17/13	16	4
B组	38	11.3±1.7	17/21	17	5
C组	29	11.9±1.9	16/13	14	4
统计值	?	F=0.945	χ²=1.17	χ²=0.497	χ²=0.116
P值	?	0.394	0.582	0.764	1.00

表1 三组患者术前基本资料的比较

?	例数	年龄（岁）	曲张程度（Ⅱ/Ⅲ，例）	左肾静脉压迫综合征（例）	其他合并症（例）
A组	30	11.8±1.2	17/13	16	4
B组	38	11.3±1.7	17/21	17	5
C组	29	11.9±1.9	16/13	14	4
统计值	?	F=0.945	χ²=1.17	χ²=0.497	χ²=0.116
P值	?	0.394	0.582	0.764	1.00

表2 三组患者术后并发症发生率及阴囊不适改善率的比较

?	例数	阴囊水肿（例）	鞘膜积液（例）	复发（例）	阴囊不适改善率（例）
A组	30	8	7	3	14
B组	38	4	2	2	18
C组	29	1	0	1	16
χ²值	?	7.30	10.7	1.18	0.634
P值	?	0.035	0.001	0.663	0.801

表2 三组患者术后并发症发生率及阴囊不适改善率的比较

?	例数	阴囊水肿（例）	鞘膜积液（例）	复发（例）	阴囊不适改善率（例）
A组	30	8	7	3	14
B组	38	4	2	2	18
C组	29	1	0	1	16
χ²值	?	7.30	10.7	1.18	0.634
P值	?	0.035	0.001	0.663	0.801

[1]	Samplaski MK,Lo KC,Grober ED, et al. Varicocelectomy to "upgrade" semen quality to allow couples to use less invasive forms of assisted reproductive technology[J]. Fertil Steril, 2017, 108(4): 609-612.
[2]	Kohn TP,Kohn JR,Pastuszak AW. Varicocelectomy before assisted reproductive technology: are outcomes improved?[J]. Fertil Steril, 2017, 108(3): 385-391.
[3]	Locke JA,Noparast M,Afshar K. Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials[J]. J Pediatr Urol, 2017, 13(5): 437-445.
[4]	de Los Reyes T,Locke J,Afshar K. Varicoceles in the pediatric population: Diagnosis, treatment, and outcomes[J]. Can Urol Assoc J, 2017, 11 (1-2Suppl1): S34-S39.
[5]	Sack BS,Schäfer M,Kurtz MP. The Dilemma of Adolescent Varicoceles: Do They Really Have to Be Repaired?[J]. Curr Urol Rep,2017, 18(5): 38.
[6]	Moursy EE,ElDahshoury MZ,Hussein MM, et al. Dilemma of adolescent varicocele: long-term outcome in patients managed surgically and in patients managed expectantly[J]. J Pediatr Urol, 2013, 9(6): 1018-1822.
[7]	司徒杰,邱剑光,蒲小勇，等. 精索静脉曲张与左肾静脉压迫综合征相互关系的研究[J/CD]. 中华腔镜泌尿外科杂志(电子版)，2010，4(5): 414-417.
[8]	He Y,Wu Z,Chen S, et al. Nutcracker syndrome-how well do we know it?[J] Urology, 2014, 83(1): 12-17.
[9]	唐庆来,戴玉田. 睾丸微石症的临床研究进展[J]. 中华男科学杂志，2017，23(8): 734-738.
[10]	聂欢,高强利,阮安明. 睾丸微石症合并精索静脉曲张36例分析[J]. 中国性科学，2017，26(10): 5-8.
[11]	Pogorelić Z,Sopta M,Jukić M, et al. Laparoscopic varicocelectomy using polymeric ligating clips and its effect on semen parameters in pediatric population with symptomatic varicocele: a 5-year single surgeon experience[J]. J Laparoendosc Adv Surg Tech A, 2017, 27(12): 1318-1325.
[12]	Esposito C,Escolino M,Castagnetti M, et al. Two decades of experience with laparoscopicvaricocele repair in children: standardizing the technique[J]. J Pediatr Urol, 2018, 14(1): 10.e1-10.e7.
[13]	Hosseini K,Nejatifar M,Kabir A. Comparison of the efficacy and safety of palomo, ivanissevich and laparoscopic varicocelectomy in iranian infertile men with palpable varicocele[J]. Int J Fertil Steril, 2018, 12(1): 81-87.
[14]	Gómez Beltrán O,Garrido Pérez JI,García Ceballos A, et al. Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele[J]. Cir Pediatr, 2013, 26(1): 9-12.
[15]	Chiarenza SF,DAgostino S,Scarpa MG, et al. Lymphography prior to laparoscopic Palomo varicocelectomy to prevent postoperative hydrocele[J]. J Laparoendosc Adv Surg Tech A, 2006, 16(4): 394-396.
[16]	Tatem AJ,Brannigan RE. The role of microsurgical varicocelectomy in treating male infertility[J]. Transl Androl Urol, 2017, 6(4): 722-729.
[17]	Sangrasi AK,Leghari AA,Memon A, et al. Laparoscopic versus inguinal (Ivanissevich) varicocelectomy[J]. J Coll Physicians Surg Pak, 2010, 20(2): 106-111.
[18]	Bryniarski P,Taborowski P,Rajwa P, et al. The comparison of laparoscopic and microsurgical varicocoelectomy in infertile men with varicocoele on paternity rate 12 months after surgery: a prospective randomized controlled trial[J]. Andrology, 2017, 5(3): 445-450.
[19]	Feber KM,Kass EJ. Varicocelectomy in adolescent boys: long-term experience with the Palomo procedure[J]. J Urol, 2008, 180(4Suppl): 1657-1659.

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Analysis of clinical effect of three different approaches of varicocelectomy in treatment of varicocele

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Analysis of clinical effect of three different approaches of varicocelectomy in treatment of varicocele