门诊局麻下微型腹腔镜精索内静脉丝线高位结扎术临床应用.docVIP

门诊局麻下微型腹腔镜精索内静脉丝线高位结扎术临床应用 　　　为了改变泌尿外科精索静脉曲张患者需住院→开刀→抗菌→拆线→出院等传统治疗模式，也为了改变常规腹腔镜需全麻、费用高、体内残留有金属异物的状况，我们自拟麻醉药配方、剂量、给药时间，应用直径4mm微型腹腔镜，用丝线高位结扎精索内静脉，切开的后腹膜用丝线缝合关闭，避免术后出血、粘连。患者不住院，术后即可返家。临床应用31例，全部在局麻下完成手术，术时未见明显出血及脏器损伤，无1例中转手术，术后精索静脉曲张均消失，Valsalva法检查阴性。提示该术式在临床上是可行的，是一种医患都乐意接受的新术式。 　　 　　Objective: An increasing number of operative procedures in urology can be performed by laparoscopy. We report our experience with mini-laparoscopic varicocele ligation by silk suture, which is a typical operative in outpatients and a simple technique for suture ligation. Methods: Mini-laparoscopic varicocele ligation by silk suture was performed in 31 outpatients (12 to 37 years olds, 10 bilateral and 21 unilateral) since Nov.1993. With the patient under local anesthesia the pneumoperitoneurn was induecd, three-4mm-trocars were inserted, the spermatic vein was ligtured by silk suture and the retroperitoneum was sutured by silk suture.Results: All operations were completed as planned under local anesthesia. Blood loss was more minimal and there were noamp;n bsp;intraoperative or postoperative complications. Mean postoperative hospital stay is 2 hours. All patients are in out patients. Conclusions: Mini-laparoscopic varicocele ligation is feasible and minimally invasive. Its procedure can be performed in outpatients and it’s an effective and simple treatment for varicocele. 　　Key words: Varicocele; Laparoscopy; Local Anesthesia 　　我们1993年11月～1997年11月开始对精索静脉曲张自(VC)患者全部在局麻下采用微型腹腔镜用丝线在腹内对精索的内静脉进行高位结扎，后腹膜切口用内镜缝合技术进行缝扎关闭。患者术后即返家，彻底改变了该病需住院开刀治疗的现状。临床应用31例，效果良好，现报告如下： 　　1　临床资料 　　1.1　一般资料 　　本组31例，年龄12～37岁。其中不育症25例，阴囊坠胀不适3例，无症状预防性治疗3例。左侧曲张21例，双侧10例。体检判断精索静脉曲张程度：Ⅰ度1例，Ⅱ度17例，Ⅲ度13例。 　　1.2　设备与器械 　　美国Stryter电视摄录显像系统；直径4.0mm的0°或30°微型腹腔镜；三个直径5mm Trocar套管针；直径4mm分离钳和无损伤抓钳；7F医用丝线。 　　1.3　手术方式 　　术前禁食水，排空膀胱；切口位置：脐下1个，另2个位于脐外侧40～50mm处；麻醉：肌注或静注度冷丁、异丙嗪，部分病人同时口含盐酸二氢埃托啡片，切口处和腹腔内膜用利多卡因、普鲁卡因混合液局部封闭；体位：头低足高位，患侧抬高15～30°；手术操作：分别在上述切口处戳入直径5mm Trocar套管针，脐上套管内置入直径4mm微型腹腔镜，后接摄录显像系统，另2个分别置入直径4mm分离钳及无损伤抓钳，气腹压力分别维持在12～15