腹腔镜精索动静脉结扎手术治疗小儿精索静脉曲张疗效分析
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摘要
目的探讨腹腔镜精索动静脉结扎术治疗小儿精索静脉曲张的手术方法及治疗效果。方法选择2015年1月至2018年4月首都儿科研究所附属儿童医院收治并行腹腔镜精索动静脉结扎术的精索静脉曲张患儿91例,年龄10～14岁,平均12.4岁。均为左侧发病,发病时间2～48个月,平均16个月。诊断明确后行经腹腔镜精索动静脉高位结扎术。术前及术后超声评估静脉直径、双侧睾丸体积。结果 91例患儿手术时间20～50 min,平均33 min。全部患儿恢复顺利,无发热、伤口感染及睾丸肿胀等早期并发症。76例(83.5%)获得随访并行超声检查,术后6个月超声检查显示,左侧精索静脉最宽处与术前相比,平均降低了53.2%(15.6%～64.0%)。随访患儿,术后3个月、6个月、12个月时患侧睾丸平均体积与对侧相比差异均无统计学意义。所有患儿均未复发,未发生睾丸萎缩,其中8例患儿术后发现患侧鞘膜积液,定期复查均有好转。结论腹腔镜治疗小儿精索静脉曲张具有操作简单、创伤小、恢复快、并发症少的优点,是治疗小儿精索静脉曲张安全有效的方法。
Objective To analyze the therapy effects of the procedure of laparoscopic cluster ligation of the internal spermatic veins and arteries on treatment of varicocele in children. Methods From January 2015 to April 2018, 91 patients, aged from 10 to 14 years old(median age 12.4) underwent varicocele ligation using the technique for complete ligation of the internal spermatic veins and arteries. Postoperative follow-up was 3 to 24 months. A total of 76 patients had at least a 3 month follow-up including scrotal ultrasound. Results All patients had an successful operation, and the symptoms had been improved obviously. Mean operative time was 33 min(25～50 min). No postoperative recurrence or testicular atrophy was reported. Six months after operation, the diameter of internal spermatic veins was 15.6%～64.0%(53.2%)lower than that before operation. The mean testicular volume of the left side was not significantly different from that of the contralateral side at 3 months, 6 months and 12 months after operation. Eight patients(10.5%) developed hydrocele, all of which relieved slowly during our follow-up. Conclusions The procedure of cluster ligation of the internal spermatic veins and arteries for varicocele repair is safe and effective with a high success rate and low complication rate.
Objective To analyze the therapy effects of the procedure of laparoscopic cluster ligation of the internal spermatic veins and arteries on treatment of varicocele in children. Methods From January 2015 to April 2018, 91 patients, aged from 10 to 14 years old(median age 12.4) underwent varicocele ligation using the technique for complete ligation of the internal spermatic veins and arteries. Postoperative follow-up was 3 to 24 months. A total of 76 patients had at least a 3 month follow-up including scrotal ultrasound. Results All patients had an successful operation, and the symptoms had been improved obviously. Mean operative time was 33 min(25～50 min). No postoperative recurrence or testicular atrophy was reported. Six months after operation, the diameter of internal spermatic veins was 15.6%～64.0%(53.2%)lower than that before operation. The mean testicular volume of the left side was not significantly different from that of the contralateral side at 3 months, 6 months and 12 months after operation. Eight patients(10.5%) developed hydrocele, all of which relieved slowly during our follow-up. Conclusions The procedure of cluster ligation of the internal spermatic veins and arteries for varicocele repair is safe and effective with a high success rate and low complication rate.
引文
[1] Méndez-Gallart R, Bautista-Casasnovas A, Estevez-Martínez E, etal. Laparoscopic Palomo varicocele surgery:lessons learned after 10years’follow up of 156 consecutive pediatric patients[J]. J PediatrUrol, 2009, 5:126-131.
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[3] Pastuszak AW, Wang R. Varicocele and testicular function[J].AsianJ Androl, 2015, 17:659-667.
[4]谢涛.精索静脉曲张致男性不育机制的研究进展[J].国际泌尿系统杂志, 2016, 36:143-145.
[5] Nyirády P, Kiss A, Pirót L, et al. Evaluation of 100 laparoscopicvaricocele operations with preservation of testicular artery and liga-tion of collateral vein in children and adolescents[J]. Eur Urol,2002, 42:594-597.
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[7]王恩华,刘欣.精索静脉曲张对精子总数、精子活力及抑制素B的影响[J].中国男科学杂志, 2014, 28:55-57.
[8] Lenzi A, Gandini L, Bagolan P, et al. Sperm parameters after earlyleft varicocele treatment[J]. Fertil Steril, 1998, 69:347-353.
[9] Lemack GE, Uzzo RG, Schlegel PN, et al. Microsurgical repair ofthe adolescent varicocele[J]. J Urol, 1998, 160:179-181.
[10] Esposito C, Monguzzi G, Gonzalez-Sabin MA, et al. Results andcomplications of laparoscopic surgery for pediatric varicocele[J]. JPediatr Surg, 2001, 36:767-769.
[11] Kim KS, Lee C, Song SH, et al. Impact of internal spermatic arterypreservation during laparoscopic varicocelectomy on recurrenceand the catch-up growth rate in adolescents[J]. J Pediatr Urol,2014, 10:435-440.
[12] Barqawi A, Caruso A, Meacham RB. Experimental varicocele in-duces testicular germ cell apoptosis in the rat[J]. J Urol, 2004, 171:501-503.
[13]白东升,叶辉,郝春生.腹腔镜Palomo术式在小儿精索静脉曲张治疗中的应用[J].临床小儿外科杂志, 2011, 10:71-72.
[14] Fast AM, Deibert CM, Van Batavia JP, et al. Adolescent varicoce-lectomy:does artery sparing influence recurrence rate and/or catch-up growth[J]. Andrology, 2014, 2:159-164.
[15] Student V, Zatura F, Scheinar J, et al. Testicle hemodynamics in pa-tients after laparoscopic vsricocelectomy evaluated using color dop-pler sonography[J]. Eur Urol, 1998, 33:91-93.
[16]谷奇,叶辉,李龙,等.腹腔镜Palomo手术治疗小儿精索静脉曲张的研究[J].北京医学, 2013, 35:15-17.
[17] Liang Z, Guo J, Zhang H, et al. Lymphatic sparing versus lymphaticnon-sparing laparoscopic varicocelectomy in children and adoles-cents:a systematic review and meta-analysis[J]. Eur J Pediatr Surg,2011, 21:147-153.
[18]徐其涛,李守林.青少年原发性精索静脉曲张的治疗进展[J].现代泌尿外科杂志, 2015, 20:360-363.
[19]陈小珂,张峰,郑航,等.显微外科与腹腔镜精索静脉结扎术治疗精索静脉曲张的疗效[J].中华实用儿科临床杂志, 2015, 30:1276-1277.
[2] Whelan P, Laurence L. Effects of varicocelectomy on serum testos-terone[J]. Transl Androl Urol, 2016, 5:866-876.
[3] Pastuszak AW, Wang R. Varicocele and testicular function[J].AsianJ Androl, 2015, 17:659-667.
[4]谢涛.精索静脉曲张致男性不育机制的研究进展[J].国际泌尿系统杂志, 2016, 36:143-145.
[5] Nyirády P, Kiss A, Pirót L, et al. Evaluation of 100 laparoscopicvaricocele operations with preservation of testicular artery and liga-tion of collateral vein in children and adolescents[J]. Eur Urol,2002, 42:594-597.
[6]于启海,吴荣德,王刚,等.小儿精索静脉曲张的腹腔镜治疗及随访[J].中华小儿外科杂志, 2005, 26:135-137.
[7]王恩华,刘欣.精索静脉曲张对精子总数、精子活力及抑制素B的影响[J].中国男科学杂志, 2014, 28:55-57.
[8] Lenzi A, Gandini L, Bagolan P, et al. Sperm parameters after earlyleft varicocele treatment[J]. Fertil Steril, 1998, 69:347-353.
[9] Lemack GE, Uzzo RG, Schlegel PN, et al. Microsurgical repair ofthe adolescent varicocele[J]. J Urol, 1998, 160:179-181.
[10] Esposito C, Monguzzi G, Gonzalez-Sabin MA, et al. Results andcomplications of laparoscopic surgery for pediatric varicocele[J]. JPediatr Surg, 2001, 36:767-769.
[11] Kim KS, Lee C, Song SH, et al. Impact of internal spermatic arterypreservation during laparoscopic varicocelectomy on recurrenceand the catch-up growth rate in adolescents[J]. J Pediatr Urol,2014, 10:435-440.
[12] Barqawi A, Caruso A, Meacham RB. Experimental varicocele in-duces testicular germ cell apoptosis in the rat[J]. J Urol, 2004, 171:501-503.
[13]白东升,叶辉,郝春生.腹腔镜Palomo术式在小儿精索静脉曲张治疗中的应用[J].临床小儿外科杂志, 2011, 10:71-72.
[14] Fast AM, Deibert CM, Van Batavia JP, et al. Adolescent varicoce-lectomy:does artery sparing influence recurrence rate and/or catch-up growth[J]. Andrology, 2014, 2:159-164.
[15] Student V, Zatura F, Scheinar J, et al. Testicle hemodynamics in pa-tients after laparoscopic vsricocelectomy evaluated using color dop-pler sonography[J]. Eur Urol, 1998, 33:91-93.
[16]谷奇,叶辉,李龙,等.腹腔镜Palomo手术治疗小儿精索静脉曲张的研究[J].北京医学, 2013, 35:15-17.
[17] Liang Z, Guo J, Zhang H, et al. Lymphatic sparing versus lymphaticnon-sparing laparoscopic varicocelectomy in children and adoles-cents:a systematic review and meta-analysis[J]. Eur J Pediatr Surg,2011, 21:147-153.
[18]徐其涛,李守林.青少年原发性精索静脉曲张的治疗进展[J].现代泌尿外科杂志, 2015, 20:360-363.
[19]陈小珂,张峰,郑航,等.显微外科与腹腔镜精索静脉结扎术治疗精索静脉曲张的疗效[J].中华实用儿科临床杂志, 2015, 30:1276-1277.