腹腔镜下精索内静脉hemolok夹夹闭术英文版.docx

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