腹腔镜下精索内静脉hemolok夹夹闭术英文版.docx
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腹腔镜下精索内静脉hemolok夹夹闭术英文版.docx
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腹腔镜下精索内静脉hemolok夹夹闭术英文版
TheComparationBetweenPalomoOperationandLaparoscopicspermaticveinsurgery
withhemolokfolder
HUANGWeidong,LIANGXin,ZHANGChao,LINLi
(DepartmentofAndrology,XinjiangJiayinHospital,Urumqi830001,China)
Abstract:
Objective:
TheControlstudyoflaparoscopicspermaticveinsurgerywithhemolokfolderretroperitonealligationofspermaticvesselsclustertechnique(Palomotechnique)inthetreatmentefficiencyofvaricocelesurgery,clinicalefficacyandtheincidenceofcomplications.Methods:
StudywerefromJanuary2007toJune2010inourhospitalvaricocelesurgeryinparallel80patientsweredividedintotwogroupsaccordingtosurgicalprocedures,laparoscopicspermaticveinocclusionHemolokfoldersurgerygroup(Hgroup)42cases,Palomosurgerygroup(Pgroup)38cases.OperationefficiencyOUTCOMEMEASURES:
operationtime,bloodloss,hospitalstay,bowelfunctionrecoverytime;postoperativecomplicationsOUTCOMEMEASURES:
testicularedema,hydrocele,testicularpain,epididymis,epididymitis;clinicalefficacyOUTCOMEMEASURES:
sixmonthsaftersurgerysemenquality,includingspermdensity,survivalrate,abnormalityrate,A+Bclasssperm,colorDopplerexaminationCDFIspermaticvein(Dvalue),refluxtime(TRvalue)andtheflowvelocityanddiameterratio(V/D),rateofclinicalsymptomsandrelapserate.Results:
Twogroupsofpatientsbetweengroupsoperatingtime,bloodlossandhospitalstayweresignificantlylessthanPHgroup(P<0.05),postoperativeintestinalfunctionrecoverytimebetweenthetwogroupswasnotsignificant(P>0.05);edemaandpostoperativecomplicationsoftesticularhydroceleincidenceofHgroupwaslowerthanPgroup(P<0.05);testisepididymispain,epididymitisincidencebetweenthetwogroupswasnotsignificant(P>0.05);surgerysixmonthsAfterthesemenquality:
comparisongroupafteroperationcomparedwithpreoperativevaluesweresignificantlydifferent(P<0.05),beforeandaftersurgerybetweenthetwogroupsnosignificantdifferencebetweenthevalues(P>0.05).CDFIsixmonthsafteroperationcolorDopplerexaminationofspermaticveindiameter(Dvalue),refluxtime(TRvalue)andtherecurrencerateofHgroupwaslowerthanPgroup(P<0.05).Rateofclinicalsymptomsdisappeared,CDFIcheckbloodflowvelocityanddiameterratio(V/D)greaterthanthePgroup(P<0.05).Conclusion:
LaparoscopicspermaticveinocclusionsurgeryandPalomohemolokfoldercanbesignificantlyimprovedsemenqualityoperation,buttheformerhasthesurgery,shorterhospitalstay,lessbleeding,fewercomplications,betterclinicalresults,lowrecurrencerate,etc.,clinicalvaricoceleisthepreferredsurgicalprocedures.
Keywords:
Laparoscopicvaricocelesurgery;Hemolokfolder;Palomooperation
Varicoceleisacommonmalereproductivesystemdisease,itsincidenceamongmenaccountedfor10%~15%,Ⅱdegreelevelandaboveprimaryvaricocelecancausemaleinfertilityinclinical,abnormalsemenqualityandscrotum、groinbulgeandotherclincalsymptomswhichneedforsurgery.Currently,therearesurgicalligationofthespermaticcordclusterretroperitonealvascularsurgery(Palomotechnique)andmodifiedPalomolaparoscopicsurgery[1].In1991,LaparoscopicsurgeryofPalomotooktheleadcompletedbydoctorsDonovanandWinfieldoftheUnitedStates[2],Since1992theinternationalapplication.WithHemolokcaughtinthemirrorsofthewidelyusedlaparoscopicspermaticveinocclusionHemolokfolderlaparoscopicsurgeryisyetanotherdistillationofmodifiedPalomotechnique,withlesstrauma,simple,shorteroperationtime,rapidrecoveryAndsoon.Atthesametime,ensuresthathighligationofspermaticvein,whilesimpleisolatedspermaticartery,testicularandepididymalfunctioninprotectingtheroleofcertain[3]。
Thereisnoreviewofthedomesticlarge-scalestudytocomparetheclusterretroperitonealsurgeryspermaticvesselsligation(Palomotechnique)andlaparoscopicspermaticveinHemolokTheclinicaleffectofclippingfolder,thisstudywastocomparethetwosurgicaltreatmentTheefficiencyofvaricocelesurgery,clinicalefficacyandtheincidenceofpostoperativecomplicationsforsurgicalmethodsofvaricocelechoosetoprovidescientificbasis.
1SubjectsandMethods
1.1CaseSelection
InourhospitalfromJanuary2007toJune2010weretreatedinparallelsurgicaltreatmentofvaricocelepatients,80casesofcongenitalanomaliesexcludedexternalgenitalia,groin,scrotumhistoryofsurgeryorinjury,urogenitalinfections,endocrinedisorders(thehypothalamicorpituitarydysfunctionandthyroiddysfunction)ofthepatients.Dividedintotwogroups,laparoscopicspermaticveinHemolokclippingsurgerygroup(Hgroup)42cases,Palomosurgerygroup(Pgroup)38cases,theabovecaseshavedifferentdegreesofscrotalfallill,medicalearthwormscanreachthescrotumplexiform-likespermaticvenousplexus,andwereconfirmedbyultrasonography.GeneralinformationcaseinTable1,twogroupsofage,racegender,bodymassindex,location,varicosedegreeclassification,consolidationcourseofsemenabnormalitiesandnosignificantdifference(P>0.05).
1.2Surgical
1.2.1LaparoscopicspermaticveinHemolokclippingsurgerygroup
Emptythebladdercatheterizationbeforesurgery,generalanesthesiaendotrachealintubation,headlowenoughhigh.Establishmentofpneumoperitoneumintheincisionbelowthebellybutton,placed10mmTrocar,laparoscopicdirectvisionwereontherightandleftofthecorrespondingMaxwellpointsinserted5mmTrocar.Maintainthepneumoperitoneumpressure8~13.5mmHg,thepositionisslightlytiltedtothecontralateral,discerntheinnermouth,aclearinternaliliacarteryandthevasdeferenstobeprotected.Intheinternalringofabout4cmproximalvenousplexusofthespermaticcordandcutthesideoftheouterlifttheperitoneum,theupperandlowerfreespermaticvenousplexus1~1.5cm,clipdoubletoHemolokplexusspermaticveinocclusion,checknobleeding,Equipmentgauzeexhaustiveloss,withdrawalofpneumoperitoneum,laparoscopicoperationparts,suturedincision,Band-Aidtopical,awakeextubationofsurgeryinpatientswithstablevitalsigns,thesafetyandreturntowards.
1.2.2Retroperitonealligationofspermaticvesselsclustertechnique(Palomotechnique)
Withcontinuousepiduralanesthesia,anesthesiatakeseffect,patientstakesupine,theoperativefieldroutinedisinfection.AleftlowerquadrantpointsagainstMaxwellobliqueincision,long2~3cm,cutalongthedirectionofexternalobliqueaponeurosisfibers,separatedbluntabdominaloblique,transverseabdominalmuscle,cuttransversefascia.Theperitoneumintotheinsideoftheexpansionfoundintheretroperitonealspermaticvein,usuallyfrom1to2.Freeshortvein,theveinligationdual-channel,themiddlecut,thetwoendsofsilkligation.Separationprocess,suchascanbeseenbeatinginthespermaticartery,istobeavoided,ornotdeliberatelylookingfor.Checkcarefullyaroundthefillingoftheveinwillbesubjecttotheligation,soasnottomiss.Closethewoundafterbleedinglayerbylayer,didnotmentiontubedrainage.BothsidesaretakingtherightlowerquadrantobliqueincisionMaxwellpoint,surgeryfollowed.
1.3OUTCOMEMEASURES
OperationefficiencyOUTCOMEMEASURES:
operationtime,bloodloss,hospitalstay,bowelfunctionrecoverytime;postoperativecomplicationsOUTCOMEMEASURES:
testicularedema,hydrocele,testicularpain,epididymis,epididymitis;clinicalefficacyOUTCOMEMEASURES:
Sixmonthsaftersurgerysemenquality,includingspermdensity,survivalrate,abnormalityrate,A+Bclasssperm,colorDopplerexaminationCDFIspermaticvein(Dvalue),refluxtime(TRvalue)andtheflowvelocityandDiameterratio(V/D),rateofclinicalsymptomsandrelapserate.
1.4StatisticalMethods
Casesofthisretrospectivestudyscreening,group,recordmonitoringindicators,andstatisticalanalysiswerefollowedupforimplementationbythehand.MedicaluseofPEMS3.0statisticalsoftwareanalysis,measurementdatawiththemean±standarddeviationx±s)(thatthecountdatainpercentage(%)said.Betweengroupsusingttestandχ2test,measurementdatabeforeandafterthegroupusingpairedttest,significancelevelα=0.05.
Table1Comparisonoftwogroupsofpatientswithgeneralinformation(x±s)
Group
N
Age(years)
Tribes(Chinese/less)
Bodymassindex
Occurrencesite(Single/double)
Abnormalsperm
Degreeclassification(Ⅱ/Ⅲ)
Duration(months)
GroupH
42
29.90±5.51
30/12
25.15±5.63
28/14
40
26/16
10.70±1.31
GroupP
38
29.17±6.38
26/12
25.77±4.09
20/18
37
25/13
11.71±1.45
Table2PerioperativeobservationoftwogroupsofComparative(x±s)
Group
Operationtime(min)
Postoperativehospitalstay(d)
Bloodloss(ml)
Bowelfunctionrecoverytime(h)
GroupH
36.70±6.90
3.20±1.10
11.60±3.31
16.60±4.70
GroupP
49.50±8.70*
7.30±2.50*
20.50±3.83*
15.20±3.60
Note:
TheHgroup,inadditiontobowelfunctionrecoverytime,thedifferencewasstatisticallysignificant,*p<0.5
Table3Comparisonoftwogroupsofpatientswithcomplications
Group
N
Testicularedema
Hydrocele
Epididymistesticularpain
Epididymitis
GroupH
42
0
0
6
0
GroupP
38
8*
7*
6
1
Note:
TheHgroup,testicularswellingandhydrocelesignificantly,*p<0.5
Table4,thetwogroupswerecomparedsemenqualitybeforeandafteroperation(x±s)
Group
Time
Semen
Spermdensity(106/ml)
Survivalrate(%)
Deformity(%)
A+Bclasssperm(%)
GroupH
Preoperative
4.20±0.01
41±24
50±10
45±15
35±12
After
4.37±0.51
60±27#
67±15#
25±9#
65±15#
GroupP
Preoperative
4.25±0.42
45±23
51±14
44±16
33±13
After
4.20±0.31
6
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