Pogorelić Zenon, Sopta Magdalena, Jukić Miro, Nevešćanin Ana, Jurić Ivo, Furlan Dubravko
1 Department of Pediatric Surgery, University Hospital of Split , Split, Croatia .
2 School of Medicine, University of Split , Split, Croatia .
J Laparoendosc Adv Surg Tech A. 2017 Dec;27(12):1318-1325. doi: 10.1089/lap.2017.0439. Epub 2017 Oct 11.
The aim of this study was to evaluate demographic and clinical characteristics of the children undergoing laparoscopic varicocelectomy by using polymeric ligating clips and to evaluate postoperative outcomes and analyze semen according to the grade of varicocele after surgery.
The case records of 120 pediatric patients who underwent laparoscopic varicocelectomy were retrospectively reviewed. The following parameters were examined: age, grade of varicocele, lateralization, diameter of spermatic veins, indications for surgery, duration and outcomes of surgery, complications, and recurrence rate. For patients older than 16 years of age, semen analyses were obtained before and after the surgery and were compared according to the clinical grade of varicocele.
The median age of the patients was 15 years. Of the total number of patients, left-sided varicocele was found in 119 patients and bilateral varicocele was found in 1 patient. Of the 120 varicoceles, 8 (6.7%) were grade I, 58 (48.3%) were grade II, and 54 (45%) were grade III. There were no major intraoperative complications. Hydrocele was found in 2 (1.6%) patients. There were no cases of recurrence recorded. Sperm concentration (P < .01), morphology (P < .01), and motility (P < .01; P = .02) improved 6 months after surgery in patients with varicocele grades of I and II, respectively. In grade III varicocele, only sperm concentration (P < .01) and morphology (P = .03) improved whereas motility (P = .150) did not change significantly.
Laparoscopic varicocelectomy using polymeric ligating clips is a safe, feasible, and cost-effective technique, with a low rate of postoperative complications and recurrence and it significantly improves sperm parameters in adolescents.
本研究的目的是评估接受使用聚合物结扎夹的腹腔镜精索静脉高位结扎术的儿童的人口统计学和临床特征，并评估术后结果，并根据术后精索静脉曲张的分级分析精液情况。
回顾性分析120例行腹腔镜精索静脉高位结扎术的儿科患者的病历。检查以下参数：年龄、精索静脉曲张分级、侧别、精索静脉直径、手术指征、手术持续时间和结果、并发症及复发率。对于16岁以上的患者，在手术前后进行精液分析，并根据精索静脉曲张的临床分级进行比较。
患者的中位年龄为15岁。在所有患者中，119例为左侧精索静脉曲张，1例为双侧精索静脉曲张。在120例精索静脉曲张中，8例（6.7%）为I级，58例（48.3%）为II级，54例（45%）为III级。术中无重大并发症。2例（1.6%）患者出现鞘膜积液。无复发病例记录。精索静脉曲张I级和II级的患者术后6个月精子浓度（P＜0.01）、形态（P＜0.01）和活力（P＜0.01；P = 0.02）分别有所改善。在III级精索静脉曲张患者中，仅精子浓度（P＜0.01）和形态（P = 0.03）有所改善，而活力（P = 0.150）无明显变化。
使用聚合物结扎夹的腹腔镜精索静脉高位结扎术是一种安全可行且具有成本效益的技术，术后并发症和复发率低，并且能显著改善青少年的精子参数。
