摘要
目的:对照研究腹腔镜下精索内静脉Hem-o-Lock夹夹闭术与经腹膜后集束结扎精索血管术(Palomo术)治疗原发性精索静脉曲张的手术疗效。方法:研究对象为原发性精索静脉曲张并行手术治疗的患者80例,依据术式不同分为腹腔镜下精索内静脉Hem-o-Lock夹夹闭术组(H组)42例,Palomo术组(P组)38例。观察指标:手术时间、术中出血量、住院时间、肠道功能恢复时间、术后并发症,以及术后半年精子浓度、存活率、畸形率、a+b级精子百分率,彩色多普勒血流显像(CDFI)检查精索静脉内径(D值)、返流时间(TR值)和血流速度与内径比值(V/D),临床症状消失率和复发率。结果:手术时间、术中出血量和住院时间H组少于P组(P<0.05),术后肠道功能恢复时间H组大于P组(P<0.05);术后并发症发生率两组无显著性差异(P>0.05);术后半年复查精液质量和彩色多普勒CDFI检查:组内比较术后各指标均较术前有显著改善(P<0.05),组间比较术前术后各值差异无统计学意义(P>0.05);两组术后18个月均无复发。结论:腹腔镜下精索内静脉Hem-o-Lock夹夹闭术和Palomo术均可明显改善精索静脉曲张患者精液质量,缓解并逐步消失其临床症状,但前者具有手术、住院时间更短,术中出血、术后并发症较少,临床疗效好、复发率低等优点,是当前临床治疗精索静脉曲张的优选术式。
Objective： To evaluate the clinical effects of laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips and retroperitoneal ligation of the spermatic vessel（Palomo procedure） in the treatment of primary varicocele.Methods： We included in this study 42 varicocele patients treated by laparoscopic occlusion of the internal spermatic vein with Hem-o-Lock clips（Hem-o-Lock group） and another 38 treated by Palomo procedure（Palomo group）.We recorded the operation time,intraoperative blood loss,hospital stay,bowel function recovery time,post-operative complications,as well as such seminal parameters as sperm concentration,sperm motility,sperm abnormality and the percentage of grade a ＋ b sperm 6 months after surgery.We measured the interior diameter and reflux time of the spermatic vein and the ratio of flow velocity to the diameter using color Doppler flow imaging（CDFI）,and observed the disappearance and recurrence of clinical symptoms.Results： Intraoperative blood loss was markedly less and the operation time,postoperative hospital stay and intestinal function recovery time significantly shorter in the Hem-o-Lock than in the Palomo group（P 0.05）,but there were no statistically significant differences in the incidence of postoperative complications（P 0.05）.Six months after surgery,seminal parameters and the results of CDFI were significantly improved in both the Hem-o-Lock and Palomo groups（P 0.05）,but with no significant difference between the two（P 0.05）.No recurrence was found in either group at 18 months.Conclusion： Both laparoscopic spermatic vein occlusion with Hem-o-Lock clips and Palomo procedure can improve the semen quality and relieve the clinical symptoms of primary varicocele patients,but the former is even more preferable for its shorter operation time and hospital stay,less intraoperative bleeding,fewer complications,better clinical outcomes,and lower rate of recurrence.
出处
《中华男科学杂志》
CAS
CSCD
2012年第4期339-343,共5页
National Journal of Andrology
