摘要
目的：探讨采用自制套管行经脐单孔腹腔镜精索内静脉高位结扎术的可行性和初步经验。方法：2012年12月-2014年11月我院对106例确诊精索静脉曲张患者行自制套管经脐单孔腹腔镜下精索内静脉高位结扎术,患者平均年龄23（18-31）岁,平均BMI为23.3kg/m2,单纯左侧78例,双侧28例。所有手术均选择脐部半环形2cm切口,采用两个直径分别为5cm和7cm的塑料环和一只7.5号无菌手套制作成的单孔套管,建立手术入路后使用常规腹腔镜器械完成手术。结果：106例患者手术均顺利完成,单侧手术时间平均（40.3±6.2）min,双侧手术时间平均（62.4±7.6）min,术中出血量均少于10ml,无中转开放手术或增加附加套管,围手术期无并发症发生,平均术后住院时间为3（2-5）d。术后随访1-6个月,阴囊内静脉团块消失,阴囊坠胀感均有不同程度缓解,静脉曲张均无复发,脐部切口愈合好,未见明显手术瘢痕,无脐疝、肠粘连、睾丸萎缩等并发症发生,51例术前精液检查异常患者,术后3个月复查精液常规,37例精子活动率较术前明显提高（P〈0.05）。结论：自制套管经脐单孔腹腔镜行精索内静脉高位结扎术治疗精索静脉曲张安全可行,疗效满意,术后腹部无明显可见瘢痕,具有一定的美观效果,但远期疗效尚待观察,手术器械有待进一步改进。
Objective：To explore the feasibility and preliminary experience of transumbilical single-port laparoscopic varicocelectomy using self-made single-port device.Method：From December 2012 to November 2014,a total of 106 cases with varicocele underwent transumbilical single-port laparoscopic varicocelectomy using self-made single-port device.The mean age was 23（range,18-31）years old and the mean BMI was 23.3kg/m2.The left operations were performed in 78 cases,while bilateral operations in 28 cases.All procedures were carried out through the 2cm umbilical semicircular incision by using the self-made single-port device.The device was made of two plastic rings and one No.7.5sterile glove.The two rings were 5cm in diameter and 7cm in diameter.Standard laparoscopic instruments were used after finishing surgical exposures.Result：All 106 cases were performed successfully without conversion to open surgery or additional trocar.The unilateral mean operation time was（40.3±6.2）min,and the bilateral mean operation time was（62.4±7.6）min.The intraoperative blood loss was less than 10 ml.No perioperative complication was found.The mean postoperative hospital stay was 3（range,2-5）d.The follow-up period was 1-6months.The scrotal veins masses disappeared,and the scrotum bulge relieved.Umbilical incision healed well without obvious scar,and varicose veins didn＇t recur.No umbilical hernia,intestinal adhesion or testicular atrophy was found.Thirty-seven of 51 cases whose reports of preoperative semen examination were abnormal were found significantly higher sperm activity rate（P 〈0.05）three months postoperatively.Conclusion：Transumbilical single-port laparoscopic varicocelectomy using self-made single-port device is safe and feasible.The curative effect is satisfactory and no obvious scar is observed.This procedure has a favorable cosmetic effect.However,its long-term efficacy remains to be evaluated,and the surgical instruments need further improvement.
出处
《临床泌尿外科杂志》
2015年第10期876-878,882,共4页
Journal of Clinical Urology
关键词
精索静脉曲张
单孔腹腔镜手术
varicocele
laparoendoscopic single-site surgery
