显微镜下和腹腔镜下精索静脉结扎术中情况及术后并发症比较.docVIP

显微镜下和腹腔镜下精索静脉结扎术中情况及术后并发症比较 　　【摘要】目的：比较显微镜下和腹腔镜下精索静脉结扎术中结扎静脉、动脉和淋巴管保留情况及术后并发症情况。方法：2014年3月至2014年6月间北大医院男科中心完成显微镜下左侧精索静脉结扎术32例，河北邯郸市第四医院完成腹腔镜下左侧精索静脉结扎术28例。比较2种术式术中结扎精索内静脉数量、保留精索内动脉和淋巴管数量。所有患者随访6个月，比较两组复发、睾丸鞘膜积液和睾丸萎缩的发生率。结果：显微镜组平均年龄279岁；腹腔镜组平均年龄254岁。两组年龄和曲张程度没有差异。显微镜组平均结扎直径大于1mm的精索内静脉108支，平均保留动脉18支和淋巴管42支；腹腔镜组平均结扎精索内静脉34支，保留动脉07支，429%的患者未保留动脉，143%（4例）的患者发现淋巴管。术后显微镜组复发0例，轻度鞘膜积液0例，睾丸萎缩0例；腹腔镜组复发2例（71%），鞘膜积液4例（143%），睾丸萎缩0例。结论：显微镜下精索静脉结扎术由于术中彻底结扎精索内静脉并保留动脉和淋巴管，因此术后并发症较腹腔镜精索静脉结扎术明显降低。 　　【关键词】精索静脉曲张；腹腔镜；显微外科；复发；鞘膜积液 　　【Abstract】Objectives： To compare the intraoperative results and postoperative complications between microsurgical and laparoscopic varicocelectomy. Methods： 32 patients with left varicoceles received microsurgical varicocelectomy in Andrology Center， Peking University First Hospital， and 28 patients received laparoscopic varicocelectomy in department of urology， the Fourth Hospital of Handan， from March to June in 2014， were selected. The number of venous ligated， artery and lymphatics reserved were compared between the two groups. All patients were followed up for at least 6 months. The recurrence rates and incidence of hydrocele and testis atrophy were compared. Results： The mean ages of microsurgery group and laparoscopic operation group were 27.9 and 25.4 years， respectively. The age and grades of varicocele were not significantly different between the two groups. The mean number of venous ligated （venous diameter1mm）， artery and lymphatics reserved in microsurgery group were 10.8， 1.8 and 4.2， respectively. The mean number of venous ligated and artery reserved in laparoscopic operation group were 3.4 and 0.7， respectively. After 6 months’ follow-up， no complication was found in microsurgery group. The incidence of recurrence and hydrocele were 7.1% and 14.3% in laparoscopic operation group. Testis atrophy was not found in this study. Conclusion： Because of the complete ligation of venous， reservation of artery and lymphatics， the complications of mi