CAJ | 학술논문

目的探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和传统开放手术(经腹股沟管精索静脉结扎术)治疗精索静脉曲张的临床疗效及差别.方法将135例精索静脉曲张手术患者按照随机数字表法分为三组,腹腔镜下精索静脉高位结扎术组(A组,50例)、改良Palomo术组(B组,70例)和传统开放手术组(C组,15例),对三组患者的手术时间、住院时间、手术费用,术前、术后1、6、12个月的精液质量进行比较,并追踪18个月内患者精索静脉曲张复发、配偶临床妊娠结果及睾丸萎缩的发生情况.结果三组患者在单侧手术时间、住院时间方面比较差异无统计学意义(P>0.05);住院费用方面A组明显高于B、C组(P<0.05),而B、C组间比较差异无统计学意义(P>0.05);三组术后精液质量均较术前有显著提高(P<0.05),但组内术后1、6、12个月精液质量各参数比较差异无统计学意义(P>0.05).术后随访18个月,C组复发率13.3%(2/15),显著高于A组的0和B组的1.4%(1/70)(P<0.05),三组配偶临床妊娠率比较差异无统计学意义(P>0.05)[A组68.0%(34/50),B组68.6%(48/70),C组66.7%(10/15)].随访期间三组均无睾丸萎缩.结论腹腔镜下精索静脉高位结扎术和改良Palomo术是治疗精索静脉曲张的安全、简单、有效的手术方式.对于单侧精索静脉曲张,改良Palomo术值得首先推荐;对于双侧和复发的精索静脉曲张,则可以优先考虑腹腔镜手术.
목적 탐토복강경하정색정맥고위결찰술、개량Palomo술화전통개방수술(경복고구관정색정맥결찰술)치료정색정맥곡장적림상료효급차별.방법 장135례정색정맥곡장수술환자안조수궤수자표법분위삼조,복강경하정색정맥고위결찰술조(A조,50례)、개량Palomo술조(B조,70례)화전통개방수술조(C조,15례),대삼조환자적수술시간、주원시간、수술비용,술전、술후1、6、12개월적정액질량진행비교,병추종18개월내환자정색정맥곡장복발、배우림상임신결과 급고환위축적발생정황.결과 삼조환자재단측수술시간、주원시간방면비교차이무통계학의의(P>0.05);주원비용방면A조명현고우B、C조(P<0.05),이B、C조간비교차이무통계학의의(P>0.05);삼조술후정액질량균교술전유현저제고(P<0.05),단조내술후1、6、12개월정액질량각삼수비교차이무통계학의의(P>0.05).술후수방18개월,C조복발솔13.3%(2/15),현저고우A조적0화B조적1.4%(1/70)(P<0.05),삼조배우림상임신솔비교차이무통계학의의(P>0.05)[A조68.0%(34/50),B조68.6%(48/70),C조66.7%(10/15)].수방기간삼조균무고환위축.결론 복강경하정색정맥고위결찰술화개량Palomo술시치료정색정맥곡장적안전、간단、유효적수술방식.대우단측정색정맥곡장,개량Palomo술치득수선추천;대우쌍측화복발적정색정맥곡장,칙가이우선고필복강경수술.
Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.