Méndez-Gallart Roberto, Bautista Casasnovas Adolfo, Estévez Martínez Elina, Rodríguez-Barca Pablo, Taboada Santomil Pedro, Armas Azucena, Pradillos Jose, Rivera Lizet, Varela Cives Ramiro
Pediatric Surgery Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain.
Arch Esp Urol. 2010 Sep;63(7):532-6.
To evaluate the incidence of hydrocele following laparoscopic Palomo varicocele ligation in pediatric and adolescents in our institution.
Between 1997 and 2009, 180 boys diagnosed as having varicocele who underwent Palomo laparoscopic ligation were evaluated retrospectively. Outcome variables recorded for analysis were age at presentation, symptoms, varicocele grade (Dubin-Amelar classification), testicular atrophy, length of hospital stay, perioperative complications, recurrence and hydrocele formation after surgery. Mean follow up was 5.8 years (6 months- 9 years).
Age at diagnosis ranged between 9 and 19 years. Mean age at operation was 14.1 ± 1.8 years. There were 177 left-side varicoceles (98%) and four cases were bilateral. Testicular atrophy was noted in 45. Mean operative time was 38 min. The last 63 surgeries were performed on a two-trocar basis with Ligasure vascular sealing device and operative time decreased significantly to 22 min. Median hospital stay was 31h. Twenty-three patients developed hydrocele (13%); 11 of these underwent Winkelman-Lord's hydrocelectomy at least 1 year after Palomo (9% of total). Of the remaining 12, two resolved spontaneously and 10 were stable at mean 4-year follow up.
Laparoscopic Palomo procedure is a safe successful method to correct varicoceles in pediatric and adolescent males. Reactive hydrocele formation following laparoscopic varicocelectomy is a worrisome problem particularly in cases with longer follow-up.
评估我院小儿及青少年患者行腹腔镜Palomo精索静脉曲张结扎术后鞘膜积液的发生率。
回顾性分析1997年至2009年间180例诊断为精索静脉曲张并接受Palomo腹腔镜结扎术的男孩。记录并分析的结果变量包括就诊时年龄、症状、精索静脉曲张分级（Dubin-Amelar分类）、睾丸萎缩、住院时间、围手术期并发症、复发情况以及术后鞘膜积液形成情况。平均随访时间为5.8年（6个月至9年）。
诊断时年龄在9至19岁之间。平均手术年龄为14.1±1.8岁。左侧精索静脉曲张177例（98%），双侧4例。45例出现睾丸萎缩。平均手术时间为38分钟。最后63例手术采用双套管法并使用Ligasure血管封闭装置，手术时间显著缩短至22分钟。中位住院时间为31小时。23例患者出现鞘膜积液（13%）；其中11例在Palomo术后至少1年接受了Winkelman-Lord鞘膜积液切除术（占总数的9%）。其余12例中，2例自行消退，10例在平均4年的随访中病情稳定。
腹腔镜Palomo手术是矫正小儿及青少年男性精索静脉曲张的一种安全有效的方法。腹腔镜精索静脉切除术后反应性鞘膜积液形成是一个令人担忧的问题，尤其是在随访时间较长的情况下。
