摘要
目的 探讨以亚甲蓝染色、保留精索淋巴管的腹腔镜精索静脉高位结扎术的可行性,并总结治疗经验及手术技巧.方法 回顾性分析2014年2月至2014年9月收治的12例精索静脉曲张患儿的临床资料.12例均为左侧,均以阴囊上方肿物就诊,其中10例伴有明显的阴囊坠胀感.所有患儿通过物理检查及B型超声确诊.其中Ⅱ级精索静脉曲张3例,Ⅲ级9例.B型超声检查表现为阴囊上方不规则血管团块,血管内径明显增宽,与对侧相比患侧睾丸体积均有不同程度缩小.手术年龄7～14岁,平均（11.42±1.78）岁.采用保留淋巴管的腹腔镜精索静脉高位结扎术,手术开始前通过阴囊穿刺在睾丸鞘膜与白膜之间注入亚甲蓝1 ml并轻柔按摩,使精索淋巴管染色.结果 11例患儿淋巴管成功显色并得以保留,10例患儿保留了睾丸动脉.术中出血量少,无1例中转开放手术.手术时间45～90 min,平均（58.33±12.12）min.所有患儿在术后第1天出院,除1例外,余者均无明显阴囊肿胀.随访5个月至1年,无一例发生鞘膜积液,无一例出现明显并发症.结论 通过在睾丸鞘膜囊内注射亚甲蓝能够使精索淋巴管染色,为手术中确切地保留淋巴管提供指引,而通过该方法保留淋巴管对减少术后鞘膜积液发生的意义尚需进一步随访明确.
Objective To explore the feasibility of laparoscopic high ligation of spermatic vein with lymphatic retention and summarize treatment experiences and operative techniques.Methods From February 2014 to September 2014,retrospective analyses were performed for 12 left-sided cases of varicocele.There were scrotal mass （n =12） and associated pain （n =10）.A definite diagnosis was made on the basis of physical examination and ultrasound.The degrees were Ⅱ （n =3） and Ⅲ （n =9）.Ultrasound showed irregular vascular mass in scrotum and marked vascular dilatations.The volume of testis reduced as compared with normal side in all cases.The average operative age was （11.42 ± 1.78） （7-14） years.All patients underwent laparoscopic high-ligation of spermatic vein with lymphatic retention.And lymphatic staining of methylene blue was performed.Results Lymphatics （n =11） and testicular artery （n =10） were retained in 10 cases.None of them had a conversion into open operation.The average operative duration was （58.33 ± 12.12） （45-90） min.All discharges occurred at Day 1 post-operation.There was only one case of postoperative swelling of scrotum.During a follow-up period of 5-12 months,there was no onset of complications or hydrocele.Conclusions Lymphatics may be retained by means of methylene blue staining.However,the efficacy and safety of this technique require further validations.
作者
刘颖
毕允力
陆良生
张斌
汤梁峰
沈剑
Liu Ying Bi Yunli Lu Liangsheng Zhang Bin Tang Liangfeng Shen Jian(Department of Urology, Affiliated Children＇s Hospital, Fudan University, Shanghai 201102, China)
出处
《中华小儿外科杂志》
CSCD
2017年第6期416-419,共4页
Chinese Journal of Pediatric Surgery
