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目的比较开放手术、显微手术和腹腔镜手术治疗青少年原发性精索静脉曲张的临床疗效。方法左侧精索静脉曲张患者106例,随机分为腹膜后精索静脉高位结扎术开放手术组(37例)、腹腔镜组(35例)和显微镜组(34例),对其手术时间、术后住院时间、术后并发症,术后1年复发率进行比较。结果开放手术组、腹腔镜组和显微镜组患者术后住院时间分别为(5.25±2.65)天、(5.89±2.28)天和(4.56±1.98)天、术中出血量分别为(12.93±4.23)ml、(13.45±5.12)ml和(14.27±2.33)ml,3组间比较差异均无统计学意义(P>0.05);3组手术时间分别为(51.42±22.53)分钟、(67.23±25.33)分钟和(105.68±35.52)分钟,住院费用分别为(5230.21±1850.25)元、(11045.50±2545.67)元和(7215.75±1286.26)元,差异均有统计学意义(P<0.05),其中开放手术组手术时间最短,住院费用最低;开放手术组、显微镜组术后胃肠功能恢复时间分别为(9.65±3.62)小时和(9.76±2.74)小时,腹腔镜组为(15.85±4.65)小时,腹腔镜组长于开放手术组、显微镜组,差异有统计学意义(P<0.01),但开放手术组与显微镜组比较差异无统计学意义(P>0.05)。开放手术组出现阴囊水肿3例,睾丸鞘膜积液1例,伤口感染1例;腹腔镜组出现阴囊水肿2例;显微手术组无并发症发生,并发症发生率在开放手术组、腹腔镜组、显微镜组分别为13.5%(5/37)、5.7%(2/35)和2.9%(1/34);共复发4例,3组分别为8.1%(3/37),2.8%(1/35)和0.0%(0/34)。3种手术方式平均睾丸体积高于术前的平均睾丸体积,但3种手术组间比较差异无统计学意义(P>0.05)。结论显微手术在术后复发及并发症等方面优于开放手术和腹腔镜手术,显微手术创伤小,术后恢复快,疗效切确易于被患者接受。
Objective To compare the clinical effects of open surgery, microsurgery and laparoscopy in the treatment of adolescent primary varicocele. Methods A total of 106 patients with varicocele on the left were randomly divided into three groups: open surgery group (37 cases), laparoscopic group (35 cases) and microscope group (34 cases). The operative time, Postoperative hospital stay, postoperative complications, postoperative 1 year recurrence rates were compared. Results The postoperative hospital stay in open surgery group, laparoscopic group and microscopy group were (5.25 ± 2.65) days, (5.89 ± 2.28) days and (4.56 ± 1.98) days, respectively. The mean intraoperative blood loss were (12.93 ± 4.23) ml, (13.45 ± 5.12) ml and (14.27 ± 2.33) ml respectively. There was no significant difference among the three groups (P> 0.05). The operation time of the three groups were (51.42 ± 22.53) minutes and (67.23 ± 25.33) (105.68 ± 35.52) minutes and hospitalization costs were (5230.21 ± 1850.25) yuan, (11045.50 ± 2545.67) yuan and (7215.75 ± 1286.26) yuan respectively, the differences were statistically significant (P <0.05) The operation time was the shortest and hospitalization cost was the lowest. The recovery time of gastrointestinal function after operation was (9.65 ± 3.62) hours and (9.76 ± 2.74) hours respectively in open surgery group and microscope group, (15.85 ± 4.65) hours in laparoscopic operation group, There was no significant difference between open surgery group and microscope group (P> 0.05). There was no significant difference between open surgery group and microscope group (P> 0.05). In the open operation group, there were 3 cases of scrotal edema, 1 case of testicular hydrocele, 1 case of wound infection, 2 cases of scrotal edema in laparoscopic group, and no complication in microsurgery group. The incidence of complications in open surgery group, (5/37), 5.7% (2/35) and 2.9% (1/34) respectively in the mirror group and the microscope group. In the 4 groups, there were 8.1% (3/37), 2.8% (1/35) and 0.0% (0/34). The average testicular volume of the three kinds of surgical procedures was higher than that of the preoperative testicular volume, but there was no significant difference between the three surgical groups (P> 0.05). Conclusion Microsurgery is superior to open surgery and laparoscopic surgery in postoperative recurrence and complications. The microsurgery is less traumatic and the postoperative recovery is faster. The curative effect is easy to be accepted by patients.