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不同手术方式治疗精索静脉曲张的疗效比较
作者:

刘洪志1   彭华2  李硕丰3 肖永双3  陈跃3  李海龙3  温儒民3

Authors: Liu Hongzhi1, Peng Hua2, Li Shuofeng3, Xiao Yongshuang3, Chen Yue3, Li Hailong3, Wen Rumin3
单位: 1徐州医科大学研究生学院 221002;2徐州市第三人民医院泌尿外科 221002;3徐州医科大学附属医院泌尿外科 221002
Units: 1Graduate School of Xuzhou Medical University, Xuzhou 221002, China; 2Department of Urology, Third People′s Hospital of Xuzhou City, Xuzhou 221002, China; 3Department of Urology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
关键词: 精索静脉曲张;腹腔镜;显微镜检查;精索静脉高位结扎术;疗效比较研究
Keywords: Varicocele;Laparoscopes;Microscopy; High varicocele ligation;Comparative effectiveness research
分类号:
出版年,卷(期):页码:2020,47(1):35-40
摘要:

 目的  比较腹膜后精索静脉高位结扎术、经脐单孔腹腔镜手术、显微镜手术3种不同手术方式治疗精索静脉曲张的疗效。方法  回顾性分析2016年9月—2018年9月徐州医科大学附属医院收治的150例精索静脉曲张患者的病例资料,平均年龄24.5岁,年龄范围为22~30岁。根据手术方式不同将患者分为3组:开放组、腹腔镜组和显微镜组,每组各50例。开放组患者采用腹膜后精索静脉高位结扎术治疗,腹腔镜组患者采用经脐单孔腹腔镜手术治疗,显微镜组患者采用显微镜手术治疗;比较3组患者的手术时间、术后住院时间、住院费用、保留动脉、手术并发症(如睾丸鞘膜积液、阴囊水肿、附睾炎、睾丸萎缩)、复发情况、精液质量改善情况。计量资料以均数±标准差(Mean±SD)表示,两组间的比较采用t检验,多组间的比较采用方差分析;计数资料组间比较采用χ2检验。结果  显微镜组患者的手术时间[(52.52±4.29) min]较开放组[(36.60±3.69) min]及腹腔镜组[(39.54±2.87) min]长,两两比较差异具有统计学意义(P<0.05);但显微镜组患者的术后住院时间[(2.16±0.95) d]、住院费用[(5 251±300)元]较开放组[(3.80±0.78) d、(6 475±415)元]及腹腔镜组[(3.28±1.01)d、(7 379±273)元]少,两两比较结果显示,显微镜组与开放组、腹腔镜组比较差异具有统计学意义(P<0.05);并且显微镜组患者的保留动脉47例(94.0%)较开放组35例(70.0%)及腹腔镜组30例(60.0%)优势明显,两两比较结果显示,显微镜组与开放组、腹腔镜组比较差异具有统计学意义(P<0.05)。术后随访半年,显微镜组失访2例,开放组失访1例,腹腔镜组失访5例。显微镜组患者并发症总发生率为4.2%(2/48),开放组患者为28.6%(14/49);腹腔镜组患者为20.0%(9/45),两两比较结果显示,显微镜组与开放组、腹腔镜组比较差异具有统计学意义(P<0.05)。显微镜组复发率为2.1%(1/48),开放组复发率为18.4%(9/49),腹腔镜组复发率为13.3%(6/45);复发率两两比较结果显示,显微镜组与开放组、腹腔镜组比较差异具有统计学意义(P<0.05)。显微镜组精液质量改善率为68.8%(33/48),开放组为42.9%(21/49), 腹腔镜组为55.6%(25/45),显微镜组与开放组、腹腔镜组比较差异具有统计学意义(P<0.05)。 结论  显微镜手术创伤小、术后恢复快、手术费用及住院时间短,术后并发症及复发、精液质量改善等方面均优于开放精索静脉高位结扎和经脐单孔腹腔镜手术,是治疗精索静脉曲张安全有效的方式。

 Objective To compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal singleport laparoscopy and microscopy on varicocele. Methods  Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018. The average age was 24.5 years, and the age range was 2230 years. The patients were divided into three groups according to different surgical methods: open group, laparoscopy group and microscope group, with 50 cases in each group. Patients in the open group were treated with retroperitoneal spermatic cord ligation. Patients in the laparoscopic group were treated with singlehole laparoscopic laparoscopic surgery. Patients in the microscope group were treated with microscope surgery. Operation time, postoperative hospitalization time, hospitalization cost reserved arteries, surgical complications (such as testicular hydrocele, scrotal edema, epididymitis, testicular atrophy), recurrence, and semen quality improvement were compared between three groups. Measurement data were expressed as mean ± standard deviation(Mean±SD), the two comparisons  used the t test, the comparison between the three groups  used the analysis of variance, and the comparison between the count data groups using the Chi\|square test. Results  The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60±3.69) min] and the laparoscopic group [(39.54±2.87) min]. The difference between the two groups was statistically significant (P<0.05); but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d, (5 251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d, (64 75±415) yuan)]and the laparoscopic group [(3.28±1.01)d, (7 379±273) yuan] . The results of pairwise comparison showed that the difference between the microscope group, the open group and the laparoscopic group was statistically significant (P<0.05). Arterial preservation in the microscope group [47(94.0%)] were compared with  the open group [35 (70.0%)], and  laparoscopic group [30(60.0%)] had obvious advantages. Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P<0.05). After followup for six months, 2 cases were lost to followup in the microscope group, 1 cases were lost to the open group, and 5 case was lost to the unilateral laparoscopic group. 2(4.2%) patients had complications in the microscope group, and 14 (28.6%) patients had complications in the open group; 9 (20.0%) patients had complications in the laparoscopic group, and the total incidence of complications showed a pairwise comparison, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05). The recurrence rate in the microscope group was 2.1% (1/48), the recurrence rate in the open group was 18.4% (9/49), and the recurrence rate in the laparoscopic group was 13.3% (6/45); the recurrence rate was compared in pairs, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05) . The improvement rate of semen quality in the microscope group was 68.8% (33/48), the open group was 42.9%(21/49), the laparoscopic group was 55.6%(25/45), pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group, the difference were statistically significant (P<0.05).Conclusions  Microscopic surgery has less trauma, faster postoperative recovery, shorter operation cost and hospitalization time. Postoperative complications and recurrence, and improved semen quality are all superior to open spermatic vein ligation and single\|hole umbilical laparoscopic surgery, it is a safe and effective way to treat varicocele.

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