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目的:分析腹腔镜下Palomo术与改良Palomo术治疗精索静脉曲张的可行性。方法:选取2013年7月-2015年7月收治的100例精索静脉曲张患者,分别采取Palomo术(50例)与改良Palomo术(50例)治疗,对比分析两种术式术后资料。结果:Palomo组手术时间、术中出血量明显优于改良组(P<0.05)。Palomo组睾丸萎缩率、并发鞘膜积液率、术后复发率分别为4.00%、20.00%、2.00%,改良组分别为0、0、6.00%,组间比较,差异具有统计学意义(P<0.05)。Palomo组36例(72.00%)精液质量改善,改良组44例(88.00%)精液质量改善,改良组优于Palomo组(P<0.05)。改良组中有2例(4.00%)术中中转Palomo术。结论:在技术成熟的条件下,通过原位、纵向、逐条静脉分离法优化后的改良Palomo术,是治疗精索静脉曲张的首选术式,尤其是对未生育患者,采取改良Palomo术可保留精索内动脉,改善精液质量。
Objective: To analyze the feasibility of laparoscopic Palomo surgery and modified Palomo surgery for varicocele. Methods: A total of 100 patients with varicocele who were treated from July 2013 to July 2015 were enrolled in this study. Palomo surgery (50 cases) and modified Palomo surgery (50 cases) were performed respectively. The postoperative data were compared between the two methods. Results: The operation time and intraoperative blood loss in the Palomo group were significantly better than those in the modified group (P <0.05). Palomo group testicular atrophy rate, concurrent hydrocele rate, postoperative recurrence rates were 4.00%, 20.00%, 2.00%, respectively, the modified group were 0,0,6.00%, respectively, between groups, the difference was statistically significant (P <0.05). Semen quality was improved in 36 patients (72.00%) in Palomo group, while semen quality was improved in 44 patients (88.00%) in modified group, which was better than that in Palomo group (P <0.05). In the modified group, 2 patients (4.00%) received intraoperative Palomo surgery. CONCLUSION: Under the mature conditions, modified Palomo’s technique optimized by in situ, longitudinal and step-by-step venous isolation is the first choice to treat varicocele. Especially for non-fertile patients, modified Palomo operation can be reserved Intra-spermatic artery to improve semen quality.