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目的比较双孔三通道腹腔镜与显微外科手术治疗精索静脉曲张的疗效及并发症。方法 2012年1月至2013年9月将33例精索静脉曲张患者随机分成两组:双孔三通道腹腔镜精索静脉高位结扎术组(18例),显微镜下精索静脉结扎术组(15例)。对两组患者临床疗效及并发症进行对比分析。术后3月对切口美观度进行评分。结果双孔三通道腹腔镜组手术时间明显短于显微外科组(P<0.05),两组住院时间比较差异不显著。双孔三通道腹腔镜与显微外科精索静脉结扎术后精子浓度、精子活动率与(a+b)级精子百分率均较术前明显改善(P<0.05),两组之间比较无统计学差异(P>0.05)。双孔三通道腹腔镜组术后随访1例患侧出现睾丸鞘膜积液,1例精索静脉曲张复发,而显微外科组无鞘膜积液及复发,两组均未见睾丸萎缩。观察术后3月切口美观度双孔三通道腹腔镜组优于显微外科组,评分比较差异有统计学意义(P<0.05)。结论双孔三通道腹腔镜及显微外科精索静脉高位结扎术均具有创伤小、恢复快和疗效确切等优点。显微外科并发症少,复发率低:双孔三通道腹腔镜手术简便,学习曲线短,美观效果突出,便于基层医院推广与普及。
Objective To compare the curative effect and complications of laparoscopy and microsurgery for the treatment of varicocele with double-hole and triple-channel laparoscopy. Methods From January 2012 to September 2013, 33 patients with varicocele were randomly divided into two groups: double-hole three-channel laparoscopic varicocele ligation (18 cases), microsurgical varicocele ligation 15 cases). The clinical efficacy and complications of the two groups were compared. The degree of incision aesthetics was scored in March after surgery. Results The operation time of double-hole triple-channel laparoscopic group was significantly shorter than that of microsurgical group (P <0.05). There was no significant difference in hospitalization time between the two groups. The results of sperm concentration, sperm motility and (a + b) spermatozoa percentage were significantly improved after laparoscopic and microsurgical varicocelectomy (P <0.05). There was no statistical difference between the two groups Learning difference (P> 0.05). Two-hole three-channel laparoscopic group were followed up 1 case of testicular hydrocele occurred, 1 case of varicocele recurrence, microsurgery group without sheath effusion and recurrence, no testicular atrophy in both groups. Observed at 3 months after the incision aesthetics two-hole three-channel laparoscopic group was better than the microsurgical group, the score was significantly different (P <0.05). Conclusions Double hole three-channel laparoscopy and microsurgical varicocele ligation have the advantages of less trauma, faster recovery and definite curative effect. Less complications of microsurgery, recurrence rate is low: two-port three-channel laparoscopic surgery is simple, short learning curve, beautiful appearance, easy to promote the popularization and primary hospital.