肠粘连松解术在腹腔镜精索静脉高位结扎术中应用探究.doc

肠粘连松解术在腹腔镜精索静脉高位结扎术中应用探究【摘要】目的:研究肠粘连松解术在腹腔镜精索静脉高位结扎术中的应用及临床意义。方法:对以下腹部坠胀不适症状为主要就诊原因的194例精索静脉曲张患者进行研究。194例患者均采用腹腔镜行精索静脉高位结扎术,术中腹腔镜直视下发现其中168例患者伴有下腹部肠粘连。采用随机对照性研究,将168例患者随机分为二组,A组75例,单纯行腹腔镜精索静脉高位结扎术,B组93例,行腹腔镜精索静脉高位结扎术+肠粘连松解术。所有患者术前均经B超证实为精索静脉曲张。术前记录患者精索静脉曲张程度,并记录患者下腹疼痛及坠胀不适情况、阴囊坠胀及阴囊潮湿等症状。术中腹腔镜直视下记录患者腹腔肠粘连情况。术后1个月、3个月、6个月分别随访一次,观察患者相应症状改善情况。结果:A、B两组共168例患者均顺利完成手术。术后2～3天出院,无手术并发症发生。术后第1、3、6个月随访,A、B两组在阴囊坠胀不适,睾丸疼痛、阴囊潮湿等症状的消除缓解上均有明显改善,两组无明显差异;在下腹疼痛、坠胀不适等症状的缓解消除上,两组有明显差异,B组明显优于A组。结论:对于精索静脉曲张的患者,如合并下腹疼痛、坠胀不适等症状,应考虑同时存在肠粘连的可能。行腹腔镜精索静脉高位结扎术时,可同时行肠粘连松解术,对于下腹疼痛、坠胀不适等症状的缓解和消除有明显效果。 【关键词】精索静脉曲张;肠粘连;腹腔镜手术 【中图分类号】R65 【文献标识码】A 【文章编号】1008-6455(2010)08-0150-03 The research on the application of laparoscopic adhesiolysis in the laparoscopic varicoceletomy Ma Wenyi SU-Rong 【Abstract】Objective:To investigate the clinical value of the application of the laparoscopic adhesiolysis in the laparoscopic varicoceletomy.Methods:From October 2004 to December 2005,342 varicocele(VC) patients were treated by the laparoscopic varicoceletomy in our center,of these cases,192 patients who had the abdominal complain were studied in this research. Among the cases, 168 were found had the intestinal adhesion during the laparoscopic surgery, and these 168 cases were randomly divided into two groups: Group A: 75 cases, treated only with laparoscopic varicoceletomy. Group B: 93 cases, treated with laparoscopic varicoceletomy and adhesiolysis. All the cases were confirmed by the B ultrasonography as VC before the surgery. The degree of the VC, the patient?s main complaint, such as the lower abdominal pain and discomfort, the testicular pain, heaviness and moist of the scrotum, were recorded before the operartion. During the surgery, the degree of the adhesion was recorded. Follow up were taken on the 1st, 3rd, 6thmonth after the operation, and the curative effect are recorded.Results:All the cases were underwent a successful operation, and had no complications. Follow up were taken on the 1st,