腹腔镜下精索内静脉hemolok夹夹闭术英文版Word下载.docx
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腹腔镜下精索内静脉hemolok夹夹闭术英文版Word下载.docx
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0.05),postoperativeintestinalfunctionrecoverytimebetweenthetwogroupswasnotsignificant(P>
0.05);
edemaandpostoperativecomplicationsoftesticularhydroceleincidenceofHgroupwaslowerthanPgroup(P<
0.05);
testisepididymispain,epididymitisincidencebetweenthetwogroupswasnotsignificant(P>
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:
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±
Operationtime(min)
Postoperativehospitalstay(d)
Bloodloss(ml)
Bowelfunctionrecoverytime(h)
36.70±
6.90
3.20±
1.10
11.60±
3.31
16.60±
4.70
49.50±
8.70*
7.30±
2.50*
20.50±
3.83*
15.20±
3.60
Note:
TheHgroup,inadditiontobowelfunctionrecoverytime,thedifferencewasstatisticallysignificant,*p<0.5
Table3Comparisonoftwogroupsofpatientswithcomplications
Testicularedema
Hydrocele
Epididymistesticularpain
Epididymitis
6
8*
7*
1
TheHgroup,testicularswellingandhydrocelesignificantly,*p<0.5
Table4,thetwogroupswerecomparedsemenqualitybeforeandafteroperation(x±
Time
Semen
Spermdensity(106/ml)
Survivalrate(%)
Deformity(%)
A+Bclasssperm(%)
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±
4.25±
0.42
23
51±
14
44±
16
33±
13
0.31
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