腹腔镜双侧精索静脉高位结扎术.DOCVIP

临床医学论文-腹腔镜双侧精索静脉高位结扎术 【摘要】? 目的：探讨腹腔镜双侧精索静脉高位结扎术治疗精索静脉曲张的手术方法与疗效。方法：回顾分析腹腔镜双侧精索静脉高位结扎28例的临床资料。结果：手术均获成功，术中基本无出血，术后肠功能恢复后出院。平均住院１５d。复查示曲张静脉明显减轻或消失，随访６～１２个月，２１例不育症精液分析较术前明显改善，１８例在术后１年内配偶成功妊娠，无１例复发。结论：应用腹腔镜双侧精索静脉高位结扎有患者创伤小，避免漏扎静脉，手术操作简单，易掌握，不分离血管避免了出血，不造成睾丸萎缩，康复快，成功率高等优点，是值得临床推广的术式。 　　【关键词】? 精索静脉曲张；精索内静脉高位结扎术；腹腔镜　　　Application of laparoscopy in high ligation of double spermatic cord vein 　　【Abstract】? Ｏbjective:To explore the method and effect of laparoscopic high ligation of double spermatic cord vein.Methods:The clinical data of 28 cases receiving laparoscopic high ligation of double spermatic cord vein were analyzed retrospectively.Results:All operations proved to be successful.In operations,on the whole,the phenomenon of bleeding was avoided.After the operation,the function of the intestine of patients returned soon,the average hospitalization was only 1.5 days.countercheck(or callback):After operations the varicose veins showed the sign of great relief or even disappear.The followup ranged from 6 months to 12 months.In 21 cases with infertility,the quality of their spermatic fluid showed a great improvement compared with that before the operations.The wives of 18 cases succeeded in pregnancy,and there was no case of reccurrence.Conclusions:There are several advantages in applying laparoscopy in high ligation of double spermatic cord vein such as minimal invision,quick recovery,avoiding leaving veins unligated and avoiding bleeding.It is worthy of being expanded. 　　【Key words】? Varicocele;High ligation of internal spermatic cord rein;Laparoscopy ??? 精索静脉曲张发病率在男性人群中为１０％～１５％［１］，因精索静脉曲张进行性加重，可导致睾丸体积缩小与精液量进行性下降，常导致不育。精索静脉结扎术可有效地改善精液质量，因而成为治疗精索静脉曲张的主要方法。２００３年３月以来我院施行腹腔镜双侧精索静脉高位结扎术治疗精索静脉曲张２８例，效果满意，现报道如下。 　　1? 资料与方法 　　11? 临床资料? 本组２８例，１６～２８岁，平均２２岁。左侧１９例，双侧９例，均为中、重度［１］。以睾丸坠胀不适就诊７例，不育症就诊２１例。体检示阴囊内可触及迂曲血管团，平卧时消失或减轻，彩色多普勒检查示血管直径１８～２８mm，平均２５mm，均经检查排除继发性精索静脉曲张。２１例不育症患者精液检查均异常。 　　12? 手术方法? 均采用腹腔途径行双侧精索静脉高位结扎术。术前排尿或留置尿管，连续硬膜外麻醉后，取２０°头低足高仰卧位，先在脐下弧形切开皮肤约１０mm，穿入气腹针，二氧化碳气腹，压力１２～１４m