经腹腔入路腹腔镜高选择性精索静脉结扎术的疗效观察

doi:10.3877/cma.j.issn.1674-3253.2020.06.012

中华腔镜泌尿外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 452 -455. doi: 10.3877/cma.j.issn.1674-3253.2020.06.012

所属专题：文献；

临床研究

经腹腔入路腹腔镜高选择性精索静脉结扎术的疗效观察

张立元¹^,^†(

), 张小康², 剡锐³, 景锁世², 常鹏程², 冷光现², 杨捷²

^1. 730000　兰州大学第一医院泌尿二科；730000　兰州大学第一医男科
^2. 730000　兰州大学第一医院泌尿二科
^3. 730000　兰州大学第一医男科

收稿日期:2020-02-28 出版日期:2020-12-01
通信作者: 张立元
基金资助:
兰州市科技计划项目(2012-1-27); 兰州市人才创新创业项目(2014-RC-66)

The clinical efficacy of transperitoneal laparoscopic high-selective varicocelectomy

Liyuan Zhang¹^,^†(), Xiaokang Zhang², Rui Yan³, Suoshi Jing², Pengcheng Chang², Guangxian Leng², Jie Yang²

^1. Department of the Second Urology, the First Hospital of Lanzhou University, Lanzhou 730000, China; Department of Andrology, the First Hospital of Lanzhou University, Lanzhou 730000, China
^2. Department of the Second Urology, the First Hospital of Lanzhou University, Lanzhou 730000, China
^3. Department of Andrology, the First Hospital of Lanzhou University, Lanzhou 730000, China

Received:2020-02-28 Published:2020-12-01
Corresponding author: Liyuan Zhang
About author:
Corresponding author: Zhang Liyuan, Email: zlyurol@163.com

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引用本文：

张立元, 张小康, 剡锐, 景锁世, 常鹏程, 冷光现, 杨捷. 经腹腔入路腹腔镜高选择性精索静脉结扎术的疗效观察[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2020, 14(06): 452-455.

Liyuan Zhang, Xiaokang Zhang, Rui Yan, Suoshi Jing, Pengcheng Chang, Guangxian Leng, Jie Yang. The clinical efficacy of transperitoneal laparoscopic high-selective varicocelectomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(06): 452-455.

目的

探讨经腹腔入路腹腔镜高选择性精索静脉结扎术的临床疗效。

方法

回顾性分析2012年12月至2018年12月，兰州大学第一医院收治的352例行腹腔镜高选择性精索静脉结扎术治疗的精索静脉曲张患者的临床资料，比较患者术后6个月与术前的症状、精液质量改善情况，统计术后1年时配偶怀孕率、复发率及并发症发生率等。

结果

术后成功随访患者341例，失访11例。术前因阴囊坠胀疼痛症状就诊者87例，术后症状消失者55例（63.21%），缓解29例（33.33%），无改善3例（3.44%）。因婚后不育就诊者254例，其中少弱精症者225例，术后6个月平均精液质量较术前显著改善（P<0.05）；其中无精子症29例，术后6个月8例（27.58%）精液中出现精子，但与术前比较差异无统计学意义（P>0.05）。术后1年配偶怀孕91例（35.82%），复发12例（3.51%），并发鞘膜积液5例（1.46%），阴囊水肿2例（0.58%），附睾炎0例，睾丸萎缩0例。

结论

经腹腔入路腹腔镜高选择性精索静脉结扎术治疗精索静脉曲张临床疗效确切。

关键词: 精索静脉曲张, 腹腔镜, 精索静脉结扎术, 不育

Objective

To evaluate the clinical efficacy of transperitoneal laparoscopic high-selective varicocelectomy for the treatment of varicocele.

Methods

The clinical data of 352 cases with varicocele treated by transperitoneal laparoscopic high-selective varicocelectomy in our hospital from December 2012 to December 2018 were analyzed retrospectively. Symptoms and semen quality at 6 months after operation were compared with those before surgery. The rate of spousal pregnancy, recurrence rate and complication rate were analyzed at 1 year postoperation.

Results

A total of 341 patients were successfully followed up and 11 patients were lost. 87 cases were treated with scrotal swelling and pain before operation. Postoperative pain disappeared in 55 cases (63.21%), relieved in 29 cases (33.33%), and did not improve in 3 cases (3.44%). 254 patients were treated for infertility after marriage, 225 among them had oligoasthenospermia,whose average semen quality at 6 months after the operation was significantly improved compared with that before the operation (P<0.05). There were 29 cases of azoospermia, and 8 cases (27.58%) had spermatozoa 6 months after the operation, but there was no significant difference with that before the operation (P>0.05). In these patients, there were 91 cases (35.82%) with spousal pregnancy, 12 cases (3.51%) with recurrence, 5 cases (1.46%) with hydrocele, 2 cases (0.58%) with scrotal edema, no case with epididymitis or testicular atrophy within 1 year after operation.

Conclusion

The clinical efficacy of transperitoneal laparoscopic high-selective varicocelectomy is positive in the treatment of varicocele.

Key words: Varicocele, Laparoscopy, Varicocelectomy, Infertility

图1 双侧精索静脉曲张手术套管位置分布

图2 精索静脉结扎术术中游离并结扎精索静脉，保留睾丸动脉、淋巴管

表1 225例精索静脉曲张伴少弱精症者患者手术前后的精子质量比较（±s）

时间	精子浓度(10⁶/mL)	向前运动精子率(%)	精子总活力(%)	精子畸形率(%)
术前	15.0±8.0	22.4±5.2	30.0±8.0	99.9±1.0
术后6个月	24.9±8.0	48.9±5.3	49.6±8.0	88.9±1.2
t值	13.126	53.536	39.244	105.630
P值	<0.001	<0.001	<0.001	<0.001

表1 225例精索静脉曲张伴少弱精症者患者手术前后的精子质量比较（±s）

时间	精子浓度(10⁶/mL)	向前运动精子率(%)	精子总活力(%)	精子畸形率(%)
术前	15.0±8.0	22.4±5.2	30.0±8.0	99.9±1.0
术后6个月	24.9±8.0	48.9±5.3	49.6±8.0	88.9±1.2
t值	13.126	53.536	39.244	105.630
P值	<0.001	<0.001	<0.001	<0.001

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