Luo Dao-Sheng, Mo Jun-Hua, Li Mu, Zhang Zeng-Qiang, Lu Jian-Jun, Liang Zhen-Feng, Mi Qi-Wu, Sun Xiang-Zhou, Deng Chun-Hua
Zhonghua Nan Ke Xue. 2014 May;20(5):430-4.
To study the safety, effectiveness and feasibility of suprapubis-assisted umbilical laparoendoscopic mini-dual-site surgery (SAU-LEMDS) in the treatment of varicocele.
This study included 80 varicocele patients aged 24 - 44 (mean 28.5 +/- 2.6) years, 25 cases of grade I, 45 cases of grade II and 10 cases of grade III, 58 cases in the left side, 6 in the right and 16 in both sides, and all with asthenospermia. The patients were treated by SAU-LEMDS under subarachnoid anesthesia combined with general anesthesia in a supine position with a head-down-feet-up slope of 15 degrees. Two 5 mm trocars were inserted bilaterally at the umbilical edge, one with a 5 mm 30 degrees laparoscope placed in it, and another into the abdominal cavity below the pubic hairline with a 5 mm laparoendoscopic clipper placed in it. The operation procedure was similar to that of standard laparoscopic ligation of spermatic veins, with reservation of the spermatic artery and double-ligation of spermatic veins. And the procedure was repeated for the contralateral lesion in the bilateral cases. Postoperative follow-up was conducted for the incidences of orchiatrophy and testicular hydrocele and changes of seminal parameters.
All the operations were successful, with the mean operation time of (10 +/- 5.0) min (range 8 to 25 min) for the unilateral cases and (18 +/- 6.5) min (range 15 to 30 min) for the bilateral cases, the mean blood loss of (1.5 +/- 0.5) ml (range 1 to 2 ml), and the mean postoperative hospital stay of (2 +/- 0.5) d (range 1.5 to 3 d). The patients were followed up for 6 -24 (12 +/- 2.5) months, which showed significant improvement in sperm motility as compared with the baseline ([28.53 +/- 5.21] vs [19.62 +/- 3.56]%, P < 0.05), with 28 cases (35.0%) restored to normal. Recurrence was found in 4 cases (5.0%). Testicular hydrocele occurred in 7 cases (8.75%), but orchiatrophy in none. The scars in the umbilicus and suprapubis were invisible because of the wrinkles and pubic hair.
SAU-LEMDS is safe, effective and feasible for the treatment of varicocele. It is superior to umbilical laparoendoscopic single-site surgery (U-LESS) for its less invasiveness, simpler operation, and better cosmetic appearance.
探讨耻骨上辅助脐单孔腹腔镜双位点手术（SAU-LEMDS）治疗精索静脉曲张的安全性、有效性和可行性。
本研究纳入80例精索静脉曲张患者，年龄24 - 44岁（平均28.5±2.6岁），I级25例，II级45例，III级10例；左侧58例，右侧6例，双侧16例，均伴有弱精子症。患者在蛛网膜下腔麻醉联合全身麻醉下取仰卧位，头低脚高15度行SAU-LEMDS手术。双侧脐缘各插入一个5mm套管针，其中一个置入5mm 30度腹腔镜，另一个在耻骨联合上缘下方置入腹腔，内置5mm腹腔镜血管夹。手术步骤与标准腹腔镜精索静脉结扎术相似，保留精索动脉，对精索静脉进行双重结扎。双侧病变对侧按同法处理。术后随访观察睾丸萎缩、睾丸鞘膜积液发生率及精液参数变化。
所有手术均成功，单侧手术平均时间为（10±5.0）分钟（范围8 - 25分钟），双侧手术平均时间为（18±6.5）分钟（范围15 - 30分钟）；平均出血量为（1.5±0.5）毫升（范围1 - 2毫升）；术后平均住院时间为（2±0.5）天（范围1.5 - 3天）。患者随访6 - 24（12±2.5）个月，精子活力较术前显著改善（[28.53±5.21]% vs [19.62±3.56]%，P < 0.05），28例（35.0%）恢复正常；复发4例（5.0%）；睾丸鞘膜积液7例（8.75%），无睾丸萎缩发生。脐部和耻骨上瘢痕因皮肤皱纹和阴毛遮盖而不明显。
SAU-LEMDS治疗精索静脉曲张安全、有效、可行，与脐单孔腹腔镜单点手术（U-LESS）相比具有创伤小、操作简单、美容效果好等优点。
