Tan S M, Ng F C, Ravintharan T, Lim P H, Chng H C
Department of Surgery, Toa Payoh Hospital, Singapore.
Br J Urol. 1995 Apr;75(4):523-8. doi: 10.1111/j.1464-410x.1995.tb07276.x.
To determine the safety and efficacy of laparoscopic varicocelectomy in the treatment of symptomatic varicocele.
Indications for surgery were subfertility in 98 patients and pain in nine. All varicoceles were confirmed on Doppler ultrasound. Seventy-two per cent of the patients had left-sided varicoceles and bilateral varicoceles were seen in 27%. A three-puncture technique was used with carbon dioxide insufflation. The spermatic vessels were individually identified and clips were used to ligate the veins. The spermatic artery was preserved in all cases. The operation was performed on a day surgery basis with an average operative time of 61.4 min (56.6 min for unilateral and 75.8 min for bilateral varicocelectomy).
Morbidity was low, with pneumoscrotum in two patients and wound infection in two others. Sixty-one patients for whom pre- and post-operative seminal analyses were available showed improvement in sperm count and motility, with a concomitant fall in the percentage of abnormal sperm forms.
Laparoscopic varicocelectomy is safe and effective, causing minimal discomfort and allowing patients an early return to activity.
确定腹腔镜精索静脉曲张切除术治疗症状性精索静脉曲张的安全性和有效性。
手术适应证为98例患者存在生育力低下以及9例患者存在疼痛。所有精索静脉曲张均经多普勒超声确诊。72%的患者为左侧精索静脉曲张，27%的患者为双侧精索静脉曲张。采用三穿刺技术并进行二氧化碳气腹。分别识别精索血管，使用夹子结扎静脉。所有病例均保留精索动脉。手术在日间手术基础上进行，平均手术时间为61.4分钟（单侧精索静脉曲张切除术为56.6分钟，双侧精索静脉曲张切除术为75.8分钟）。
发病率较低，2例患者出现阴囊积气，另外2例患者出现伤口感染。61例患者可获得术前和术后精液分析结果，结果显示精子数量和活力有所改善，同时异常精子形态的百分比下降。
腹腔镜精索静脉曲张切除术安全有效，引起的不适最小，可使患者早日恢复活动。
