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目的评价腹腔镜Palomo术式丝线结扎治疗儿童精索静脉曲张的安全性和有效性。方法回顾性分析2009年1月-2011年2月在本院行腹腔镜Palomo术式治疗的17例精索静脉曲张患儿的临床资料。均为左侧单发精索静脉曲张,诊断依据查体及超声检查结果。术前行超声检查,静脉直径(3.03±0.69)mm,手术指征为有临床症状或重度(Ⅱ～Ⅲ度)精索静脉曲张,术式为腹腔镜Palomo术式。二氧化碳气腹压力1.33 kPa,置入3个Trocar。直视下于脐下置入第1个Trocar作为镜鞘,另2个置于左腹股沟区及耻骨联合上方。采用丝线双重结扎增粗的精索血管,间隔1.0～1.5 cm,双极电凝离断。结果手术均顺利完成。手术效果依据查体及术后超声检查结果综合评定。术后2 d复查彩超,患儿静脉直径明显缩小[(1.66±0.31)mm],睾丸血运良好。无手术并发症发生。术后2个月曲张的精索静脉均消失。随访无睾丸萎缩及鞘膜积液发生。结论腹腔镜下Palomo术式是治疗儿童精索静脉曲张安全有效的手术方法。
Objective To evaluate the safety and efficacy of laparoscopic palomo-operative wire ligation in children with varicocele. Methods The clinical data of 17 cases of varicocele treated by laparoscopic Palomo operation in our hospital from January 2009 to February 2011 were retrospectively analyzed. Are left single varicocele, diagnosis based on physical examination and ultrasound findings. Preoperative ultrasound examination, vein diameter (3.03 ± 0.69) mm, surgical indications for clinical symptoms or severe (Ⅱ ~ Ⅲ degree) varicocele, surgical procedures for laparoscopic Palomo surgery. Carbon dioxide pneumoperitoneum pressure 1.33 kPa, into 3 Trocar. Under direct vision under the umbilical into the first Trocar as a mirror sheath, the other two placed in the left groin area and above the pubic symphysis. Using double ligation of stenosis of the sphincter vessels, an interval of 1.0 ~ 1.5 cm, bipolar coagulation off. Results The operation was completed successfully. Surgical results based on physical examination and postoperative ultrasound findings comprehensive assessment. Color Doppler ultrasound was performed on the second day after operation, and the diameter of the vein was significantly reduced in children [(1.66 ± 0.31) mm]. The testicular blood flow was good. No surgical complications occurred. Varicocele disappeared 2 months after surgery. No testicular atrophy and hydrocephalus occurred. Conclusion Laparoscopic Palomo operation is a safe and effective surgical method for children with varicocele.