经脐单孔腹腔镜保留睾丸动脉的精索静脉高位结扎术附43例报告.docVIP

经脐单孔腹腔镜保留睾丸动脉的精索静脉高位结扎术（附16例报告） 庄志明 许振强 郑周达 沈在雄 刘洪杰 林建贵 林天旗 杨明根 【摘要】 目的 总结经脐单孔腹腔镜Ivanissevich手术经验。方法 回顾分析16例经脐单孔腹腔镜Ivanissevich手术的临床资料。术中应用hamlock夹闭并切断精索静脉6例（hamlock组），应用超声刀凝闭并切断精索静脉10例(UAS组)。结果 16例手术均获成功，睾丸动脉均得以保留。手术时间23.5±9.8min，出血量6.7±4.6mL，无腹腔脏器损伤或术后大出血等并发症，术后住院1.69±0.92d。hamlock组比UAS组手术时间明显延长（P0.01）。结论 经脐单孔腹腔镜保留睾丸动脉的精索静脉曲张高位结扎术安全可行，随着技术的娴熟、更为高位的分离精索静脉、单孔套管及操作器械的改进、超声刀的应用，使得手术操作更为简单，完全可以取代传统腹腔镜手术成为首选术式。 【关键词】经脐单孔；腹腔镜；精索静脉曲张；高位结扎；睾丸动脉；超声刀 Transumbilical single-port laparoscopic varicocelectomy of keeping testic artery in 16 cases 【Abstract】 Objective To summarize the surgical experience of transumbilical single-port laparoscopic varicocelectomy (SPLV) (Ivanissevich). Methods We collected the clinical data of 16 cases of varicocele treated by SPLV (Ivanissevich). Spermatic veins were cut by by hamlock in 6 cases（hamlock group）and ultrasonically activated shears(UAS) in 10 cases (UAS group). Results All of the operations were successfully completed without conversion to routine laparoscopic surgery or open surgery. All of the testic arteries were protected during the operation. The average operative time was 23.5?.8min and tnhe bleeding was 6.7?.6d ml. There was no intraoperative complication. The operative time of hamlock group was longer than UAS group (P0.01). Conclusions SPLV (Ivanissevich) is a feasible and safe procedure, With the maturity of the technology, the improvement of the Surgical instruments，and the application of UAS, this procedure can be generalized in clinic and replace traditional laparoscopic procedure. 【Key words】Transumbilical single-port; laparoscopiy; Varicocele;　Varicocelectomy; Testic artery; Ultrasonically activated shears(UAS) 经脐单孔腹腔镜精索静脉高位结扎术（single-port laparoscopic varicocelectomy，SPLV)是近年来国内外刚刚兴起的一项微创手术。由于操作难度大，国内外常采用较为容易操作的高位精索血管集束结扎（Palomo 术式），而采用保留睾丸动脉的SPLV(Ivanissevich术式)少有报道。2010年7月至2011年2月，我科采用SPLV(Ivanissevich术式)治疗精索静脉曲张患者16例，疗效满意。现报道如下。 1 资料与方法 1.1 一般资料 本组16例，年龄18~37岁，平均(22.21±3.54)岁。左侧13例，双侧3例，轻度1例，中度6例，重度9例。病程3个月至7年。