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目的:比较经脐单孔腹腔镜与传统腹腔镜手术治疗青少年精索静脉曲张的临床疗效。方法:2012年3月~2014年12月,70例精索静脉曲张患儿根据手术方式随机分为2组:经脐单孔腹腔镜精索静脉高位结扎组(单孔组)35例,传统腹腔镜精索静脉高位结扎组(传统组)35例。记录两组患儿基础资料;比较两组的手术时间、术中估计失血量、术后住院时间、术后疼痛程度(VAS评分)、患儿对切口瘢痕满意程度等指标。结果:2组均成功完成手术。单孔组手术时间为(38.42±6.13)min,长于传统组手术时间(31.29±4.99)min(P<0.01);单孔组术后8h疼痛评分为(3.34±1.08)分,低于传统组(4.49±1.79)分(P<0.05);单孔组术后止痛药物应用率1例(2.86%)低于传统组7例(20%)(P<0.05);术后单孔组患儿对切口的满意度评分为(4.57±0.56)分,高于传统组(4.11±0.72)分(P<0.05)。单孔组和传统组的术中出血量分别为(4.51±1.36)和(4.06±1.28)ml、术后24h疼痛评分(1.50±0.67)和(1.77±0.69)分及术后住院时间(2.34±1.08)和(2.46±0.95)d,差异均无统计学意义(P>0.05)。2组术后无切口感染,无腹壁血肿,阴囊红肿等并发症。术后随访10~16个月,平均13个月。所有病例无精索静脉曲张复发,无脐疝,无睾丸萎缩和鞘膜积液。结论:经脐单孔腹腔镜精索静脉高位结扎术治疗青少年精索静脉曲张安全、有效,手术时间长于传统腹腔镜手术,但术后疼痛轻,腹部瘢痕不明显,为青少年精索静脉曲的治疗提供了一种新的选择。
Objective: To compare the clinical efficacy of transumbilical single hole laparoscopy and conventional laparoscopic surgery for adolescent varicocele. Methods: From March 2012 to December 2014, 70 children with varicocele were randomly divided into two groups according to the surgical method: 35 cases of transabdominal varicocele (single hole group) Laparoscopic varicocele ligation group (traditional group) 35 cases. The basic data of two groups of children were recorded. The operation time, intraoperative blood loss, postoperative hospital stay, postoperative pain degree (VAS score) and satisfaction of incision scar were compared between the two groups. Results: The two groups were successfully completed surgery. The operation time of the single-hole group was (38.42 ± 6.13) min, longer than that of the traditional group (31.29 ± 4.99) min (P <0.01). The pain score of the single-hole group was (3.34 ± 1.08) (4.49 ± 1.79) points (P <0.05). The application rate of postoperative analgesic drugs in single hole group was lower than that in the traditional group (7 cases, 20%, 1 case, 2.86% The score of satisfaction with incision was (4.57 ± 0.56) points, higher than the traditional group (4.11 ± 0.72) points (P <0.05). The intraoperative blood loss of the single-hole group and the traditional group were (4.51 ± 1.36) and (4.06 ± 1.28) ml respectively, and the scores of pain (1.50 ± 0.67) and (1.77 ± 0.69) h after operation and postoperative hospital stay (2.34 ± 1.08) and (2.46 ± 0.95) d, respectively, with no significant difference (P> 0.05). No incision infection in 2 groups, no abdominal hematoma, scrotal swelling and other complications. The patients were followed up for 10 to 16 months with an average of 13 months. All cases without recurrence of varicocele, umbilical hernia, no testicular atrophy and hydrocele. CONCLUSIONS: Umbilical single hole laparoscopic high varicocele ligation is safe and effective for adolescent varicocele. The operative time is longer than that of conventional laparoscopic surgery. However, postoperative pain is mild and the scar of the abdomen is not obvious. Treatment offers a new option.