双孔法腹腔镜精索静脉高位结扎术治疗精索静脉曲张32例临床观察(1)
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[摘要] 目的：探讨双孔法腹腔镜下行精索静脉高位结扎术的方法和临床效果。方法：采用脐内和反麦氏点双孔法经腹腔镜下行精索静脉高位结扎术，术中保留精索动脉，并对术后疗效和影响进行临床研究。结果：32例患者术后随访16个月，精子密度恢复正常者占84.38%，精子存活率恢复正常者占90.63%，精子活动率(A+B级)恢复正常者占96.88%，术后精索静脉内径(1.720±0.034)mm。结论：双孔法腹腔镜下精索静脉高位结扎术损伤少、安全有效、切口美观、术后恢复快，适宜用于治疗由精索静脉曲张引起的男性少弱精子症，并能明显改善精液质量。
[关键词] 精索静脉曲张；精索静脉结扎术；腹腔镜技术；双孔法；精液质量
[中图分类号] R697+.24 [文献标识码] A [文章编号] 1673-7210(2011)12(b)-061-02
Clinical observation on laparoscopic spermatic vein ligation in the treatment of varicocele by dual-port methods
GU Qing1,2, WANG Xizhi2, ZHAO Xiping2
1.Medical College of Soochow University, Jiangsu Province, Suzhou 215006, China; 2.Suzhou Kowloon Hospital Shanghai Jiaotong University Medical School, Jiangsu Province, Suzhou 215021, China
[Abstract] Objective: To evaluate the clinical efficacy of the laparoscopic spermatic vein ligation by dual-port methods in the treatment of varicocele. Methods: The umbilical point and anti-McBurney point were chosen for laparoscopic spermatic vein ligation. The spermatic artery was preserved. The clinical data was analyzed respectively. Results: 16 months after surgery, follow-up was made in 32 patients. Normal sperm density rate was 84.38%, normal sperm survival rate was 90.63%, 96.88% patients sperm motility (A+B grade) back to normal. Mean spermatic cord vein diameter was (1.720±0.034) mm after surgery. Conclusion: The laparoscopic spermatic vein ligation by dual-port methods for varicocele is a safe and effective method, which features fewer traumas and quick recovery and an aesthetic effect, and is suitable for the treatment of oligo-asthenospermia caused by varicocele, improve the quality of semen.
[Key words] Varicocele; Spermatic vein ligation; Laparoscopic technique; Dual-port methods; Semen quality
精索静脉曲张(Varicocele，VC)是男性常见病之一，以精索静脉蔓状丛的延长、扩张和迂曲为特征，引起睾丸、附睾形态结构的改变和功能障碍，影响精液参数的变化，成为男性不育的重要原因，占男性不育症病因的第一位[1]；在男性不育中发病率为40.0%~57.4%[2]。笔者采用双孔腹腔镜下精索静脉高位结扎术治疗精索静脉曲张32例，在术后无复发、并发症少的基础上，具有损伤轻微、恢复时间短、操作简单、手术时间短、切口小而美观等诸多优点。现报道如下：
1 资料与方法
1.1 一般资料
选取2010年3月~2011年8月我科住院患者32例，年龄22~40岁，平均(27.84±5.13)岁；病程7~45个月，平均(32.63±6.91)个月；左侧精索静脉曲张28例，右侧1例，双侧3例；32例患者均有不同程度睾丸坠胀感，其中，31例因婚后不育就诊，1例精液常规正常 ......
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