自制套管经脐单孔腹腔镜手术治疗精索静脉曲张106例报告

姚志勇; 孙斌; 盛海波; 李建业; 李迪; 刘红明; 吕超; 郭和清

doi:10.13201/j.issn.1001-1420.2015.10.004

自制套管经脐单孔腹腔镜手术治疗精索静脉曲张106例报告

- 空军总医院泌尿外科(北京, 100142)

详细信息

通讯作者: 郭和清,E-mail:guoheqing@sina.com

中图分类号: R697.24

收稿日期: 2015-05-18

Transumbilical single-port laparoscopic varicocelectomy using self-made single-port device: report of 106 cases

- Department of Urology, Air Force General Hospital of PLA, Beijing, 100142, China

More Information

Corresponding author: GUO Heqing, E-mail: guoheqing@sina.com

Received Date: 18 May 2015

摘要

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23.3 kg/m²,单纯左侧78例,双侧28例。所有手术均选择脐部半环形2 cm切口,采用两个直径分别为5 cm和7 cm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10 ml,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。
- 精索静脉曲张 /
- 单孔腹腔镜手术
Abstract: 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 23.3 kg/m². The left operations were performed in 78 cases, while bilateral operations in 28 cases. All procedures were carried out through the 2 cm umbilical semicircular incision by using the self-made single-port device. The device was made of two plastic rings and one No. 7.5 sterile glove. The two rings were 5 cm in diameter and 7 cm 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 1-6 months. 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.
- varicocele /
- laparoendoscopic single-site surgery

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参考文献(12)

[1]	Jarow J P. Effects of varicocele on male fertility[J]. Hum Reprod Update, 2001, 7(1):59-64.
[2]	王效强, 张晓静, 袁荫田, 等. 腹腔镜手术治疗精索静脉曲张15例报告[J]. 腹腔镜外科杂志, 2009, 14(6):424-425.
[3]	Tracy C R, Raman J D, Cadeddu J A, et al. Laparoendoscopic single-site surgery in urology:where have we been and where are we heading[J]? Nat Clin Pract Urol, 2008, 5(10):561-568.
[4]	Lin T, Huang J, Han J, et al. Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ilealneobladder:an initial experience of 12 cases[J]. J Endourol, 2011, 25(1):57-63.
[5]	Rané A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port)[J]. Urology, 2008, 72(2):260-263; discussion 263-264.
[6]	Zhang X, Shi T P, Li H Z, et al. Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments:initial experience and short-term outcome[J]. J Urol, 2011, 185(2):401-406.
[7]	Micali S, Isgrò G, De Stefani S, et al. Retroperitoneal laparoendoscopic single-site surgery:preliminary experience in kidney and ureteral indications[J]. Eur Urol, 2011, 59(1):164-167.
[8]	Gimenez E, Leeser D B, Wysock J S, et al. Laparoendoscopic single site live donor nephrectomy:initial experience[J]. J Urol, 2010, 184(5):2049-2053.
[9]	曹华, 李桂心, 黄雄飞译. 腹腔镜手术图谱解剖与进路[M]. 福州:福建科学技术出版社, 2004:355-366.
[10]	Desai M. Single-port surgery for donor nephrectomy:a new era in laparoscopic surgery[J]? Nat Clin Pract Urol, 2009, 6(1):1.
[11]	张旭, 马鑫, 朱捷, 等. 经脐单孔腹腔镜肾切除术2例报告[J]. 临床泌尿外科杂志, 2009, 24(8):568-571.
[12]	高利军, 程书栋, 闫惠忠, 等. 单孔腹腔镜精索静脉高位结扎术86例临床研究[J]. 实用医技杂志, 2012, 19(4):406-407.