摘要
目的比较开放手术、显微手术和腹腔镜手术治疗青少年原发性精索静脉曲张的临床疗效。方法左侧精索静脉曲张患者106例,随机分为腹膜后精索静脉高位结扎术开放手术组(37例)、腹腔镜组(35例)和显微镜组(34例),对其手术时间、术后住院时间、术后并发症,术后1年复发率进行比较。结果开放手术组、腹腔镜组和显微镜组患者术后住院时间分别为(5.25±2.65)天、(5.89±2.28)天和(4.56±1.98)天、术中出血量分别为(12.93±4.23)ml、(13.45±5.12)ml和(14.27±2.33)ml,3组间比较差异均无统计学意义(P>0.05);3组手术时间分别为(51.42±22.53)分钟、(67.23±25.33)分钟和(105.68±35.52)分钟,住院费用分别为(5230.21±1850.25)元、(11045.50±2545.67)元和(7215.75±1286.26)元,差异均有统计学意义(P<0.05),其中开放手术组手术时间最短,住院费用最低;开放手术组、显微镜组术后胃肠功能恢复时间分别为(9.65±3.62)小时和(9.76±2.74)小时,腹腔镜组为(15.85±4.65)小时,腹腔镜组长于开放手术组、显微镜组,差异有统计学意义(P<0.01),但开放手术组与显微镜组比较差异无统计学意义(P>0.05)。开放手术组出现阴囊水肿3例,睾丸鞘膜积液1例,伤口感染1例;腹腔镜组出现阴囊水肿2例;显微手术组无并发症发生,并发症发生率在开放手术组、腹腔镜组、显微镜组分别为13.5%(5/37)、5.7%(2/35)和2.9%(1/34);共复发4例,3组分别为8.1%(3/37),2.8%(1/35)和0.0%(0/34)。3种手术方式平均睾丸体积高于术前的平均睾丸体积,但3种手术组间比较差异无统计学意义(P>0.05)。结论显微手术在术后复发及并发症等方面优于开放手术和腹腔镜手术,显微手术创伤小,术后恢复快,疗效切确易于被患者接受。
Objective To investigate the curative effects of different surgical methods in the treatment of adolescent patients with primary varicocele. Methods One hundred and six adolescent pa-tients with primary varicocele were randomly divided into three groups according to the operative methods：thirty-seven cases of open high level ligation of varicocele via retroperitoneum（open surgery group）,thirty-five cases of laparoscopic varicocelectomy（laparoscope group）,and thirty-four cases of microsurgical vari-cocelectomy（microsurgery group）. The operation time,postoperative hospital stay,postoperative complica-tions and recurrence rate in one year after operation were compared. Results All the operations in three groups were completed successfully. There was no significant difference in the postoperative hospital stay [（5. 25 ± 2. 65）d,（5. 89 ± 2. 28）d,（4. 56 ± 1. 98）d]and intraoperative bleeding[（12. 93 ± 4. 23）ml, （13. 45 ± 5. 12）ml,（14. 27 ± 2. 33）ml]among the three groups,respectively（P 〉 0. 05）. There were significant differences in operation time[（51. 42 ± 22. 53）min,（67. 23 ± 25. 33）min,（105. 68 ± 35. 52） min],hospital cost[（5230. 21 ± 1850. 25）Yuan,（11045. 50 ± 2545. 67）Yuan,（7215. 75 ± 1286. 26） Yuan]among three groups,respectively（P 〈 0. 05）. The open surgery group was superior to other groups in operation time and hospital cost. The postoperative restoration time of gastrointestinal function in open surgery group and microsurgery group was significantly shorter than that in laparoscope group[（9. 65 ± 3. 62）h,（15. 85 ± 4. 65）h,（9. 76 ± 2. 74）h,P 〈 0. 01],but there was no significant difference between the open surgery group and microsurgery group. Five cases of complication（2 scrotal edemas,1 hydroceles and 1 incisional infection）occurred in the open surgery group,2 cases of complication（2 scrotal edema） occurred in the laparoscopy group,and no complication occurred in the microsurgery group. The rate of complications was 13. 5%（5 / 37）,5. 7%（2/ 35）and 2. 9%（1/ 34）in three groups,and the rate of recur-rence was 8. 1%（3/ 37）,2. 8%（1/ 35）and 0. 0%（0/ 34）. The testicular volumes were improved,but there was no statistical significance among the three groups（P 〉 0. 05）. Conclusion Microsurgery is obviouslybetter than retroperitoneal high ligation and laparoscopic approaches in preventing postoperative recurrence and reduce complications. With the advantages of minor injury and quick recovery,microsurgery is easy to be accepted by most patients.
出处
《临床外科杂志》
2016年第9期703-705,共3页
Journal of Clinical Surgery
