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目的:探讨耻骨上辅助经脐微双孔腹腔镜技术(SAU-LEMDS)治疗精索静脉曲张的安全性、可行性和有效性。方法:本组80例精索静脉曲张男性患者,年龄28.5±2.6(24~44)岁。单纯左侧58例,单纯右侧6例,双侧16例。Ⅰ度25例,Ⅱ度45例,Ⅲ度10例。患者精液分析检查均为弱精子症。蛛网膜下腔麻醉联合静脉麻醉,头低脚高15°仰卧位。于脐左右侧缘分别置入一5 mm Trocar,其中一个Trocar插入分离钳或剪刀等操作器械,另一个Trocar中置入5 mm 30°腹腔镜,自耻骨联合上方阴毛覆盖区置入一5 mm Trocar及操作杆。保留精索内动脉,用丝线双重结扎精索内静脉。如为双侧病变,同法处理对侧。随访观察精液变化及睾丸萎缩、睾丸鞘膜积液发生率等指标,比较患者手术前后精液参数变化。结果:全部手术均成功。单侧手术时间10.0±5.0(8~25)min,双侧手术时间18.0±6.5(15~30)min。失血量1.5±0.5(1~2)ml,住院时间2.0±0.5(1.5~3)d,术后随访12.0±2.5(6~24)个月。精子活力(PR)明显改善[(19.62±3.56)%vs(28.53±5.21)%,P<0.05],精子活力恢复正常28例(35.0%,28/80),术后出现睾丸鞘膜积液7例(8.75%,7/80),复发4例(5.0%,4/80),没有睾丸萎缩病例。脐部切口愈合良好,被周围的皱褶所遮蔽,耻骨上小切口被阴毛覆盖,瘢痕不明显,美容效果良好。结论:SAU-LEMDS精索内静脉高位结扎治疗精索静脉曲张安全、有效、可行,与传统的经脐单孔腹腔镜(U-LESS)技术比较具有创伤更小,操作更简便,美容效果更佳的优势,值得临床推广应用。
Objective: To investigate the safety, feasibility and effectiveness of suprapubic assisted transthoracic suture (SAU-LEMDS) in the treatment of varicocele. Methods: The 80 patients with varicocele in male patients, age 28.5 ± 2.6 (24 to 44) years old. Simple left 58 cases, only the right 6 cases, bilateral 16 cases. Ⅰ degree in 25 cases, Ⅱ degree in 45 cases, Ⅲ degree in 10 cases. Patients with semen analysis were weakest sperm disease. Subarachnoid anesthesia combined with intravenous anesthesia, head low 15 ° supine position. A 5 mm Trocar was placed on the left and right sides of the umbilicus. One Trocar was inserted into operating instruments such as separation forceps or scissors. The other Trocar was placed with 5 mm 30 ° laparoscopy and a 5 mm Trocar and joystick. Retained spermatic artery, with double suture ligature spermatic vein. If the bilateral lesion, the same treatment contralateral. Follow-up observation of semen changes and testicular atrophy, testicular hydrocele incidence and other indicators, the changes in semen parameters before and after surgery. Results: All surgeries were successful. Unilateral operation time 10.0 ± 5.0 (8 ~ 25) min, bilateral operation time 18.0 ± 6.5 (15 ~ 30) min. Blood loss was 1.5 ± 0.5 (1 ~ 2) ml, hospital stay was 2.0 ± 0.5 (1.5 ~ 3) days, and follow-up was 12.0 ± 2.5 (6 ~ 24) months. The sperm motility returned to normal in 28 cases (35.0%, 28/80), and the postoperative testicular hydrocele occurred after operation ([(19.62 ± 3.56)% vs (28.53 ± 5.21)%, P < There were 7 cases (8.75%, 7/80) and 4 cases (5.0%, 4/80) recurrence. There were no cases of testicular atrophy. Umbilical incision healed well, covered by the surrounding folds, suprapubic incision was covered by pubic hair, scar is not obvious, the cosmetic effect is good. Conclusion: SAU-LEMDS high ligation of spermatic vein in the treatment of varicocele is safe, effective and feasible. Compared with the traditional U-LESS technique, SAU-LEMDS has less trauma, easier operation and more cosmetic effects Good advantage, it is worth promoting clinical application.