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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:

17

期数:

2017年3期

页码:

264-266

栏目:

经验交流

出版日期:

2017-06-20

文章信息/Info

Title:

Transumbilical Single Incision Laparoscopic Varicocelectomy for Varicoceles in Adolescents

作者:

明安晓 张军** 李龙 李旭 刘树立

首都儿科研究所附属儿童医院普外科，北京100020

Author(s):

Ming Anxiao;  Zhang Jun;  Li Long;  et al.

Department of General Surgery, Capital Institute of Pedictrics, Beijing 100020, China

关键词:

腹腔镜; 精索静脉曲张; 经脐单一部位切口

Keywords:

Laparoscopy; Varicocele; Transumbilical single incision

文献标志码:

B

摘要:

目的探讨经脐单一部位切口腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效。 方法2014年1月~2015年1月对8例小儿精索静脉曲张行经脐单一部位切口腹腔镜手术。在脐窝内纵行切开1.0 cm 皮肤,开放式置入5 mm trocar ,气腹压力10 mm Hg，在脐窝偏左侧放置第２个trocar。观察精索静脉明显扩张、迂曲，表面颜色发暗提示静脉回流障碍。经操作孔道置入剪刀，距离内环口3～5 cm处沿后腹膜表面剪开精索附近的后腹膜约2 cm。钝性分离精索血管，区分精索动静脉，无创抓钳提起精索血管，进一步游离松解精索2～3 cm。经腹壁穿入2-0带针丝线，在腹腔内单手操作打结，高位结扎精索静脉2道，切断结扎部位之间的精索静脉。结果８例患儿均在经脐单一部位切口腹腔镜下完成精索静脉高位结扎术，手术时间平均37 min（30~50 min）。脐部切口愈合好，无明显瘢痕形成。8例随访8～22个月，平均14个月，术后6个月复查左侧阴囊部位的静脉团块消失，阴囊下坠感及下腹不适症状消失，未见复发。结论经脐单一部位切口腹腔镜精索静脉高位结扎术治疗小儿精索静脉曲张，手术效果确切，腹部无可见瘢痕。

Abstract:

ObjectiveTo study the results of transumbilical single incision laparoscopic varicocelectomy for varicocele in adolescents.MethodsEight patients were involved in this study, who underwent laparoscopic varicocelectomy from January 2014 to January 2015. A 1.0 cm longitudinal incision was made in the umbilical fossa and a 5 mm trocar was introduced. Another trocar was placed in the left side. The pressure of CO2 pneumoperitoneum was 10 mm Hg. The spermatic vein was found dilated, tortuous, and with dark color. Scissors were inserted into the abdominal cavity to cut the retroperitoneum for 2 cm in length at the place 3-5 cm from the internal ring. Blunt dissection of spermatic vessels was conducted, and the spermatic vein was distinguished. The spermatic cord was further released for 2-3 cm in length. A needle with 2-0 silk thread was put into the abdominal cavity through the abdominal wall. High ligation of spermatic vein was performed with one-hand knotting and the spermatic vessel was cut off after ligation.ResultsThe single incision laparoscopic varicocelectomy was completed in all the patients. The mean operation time was 37 min (range, 30-50 min). The umbilical incision was healed smoothly without obvious scars. The mean follow-up time was 14 months (range, 8-22 months). The left-side scrotal mass was significantly reduced after 1 week of operation. The symptoms disappeared at 6 months postoperatively. No recurrence was found during the follow-up.ConclusionTransumbilical single incision laparoscopic varicocelectomy could get good efficacy in adolescents with varicocele, without obvious scars.

备注/Memo

备注/Memo:

基金项目：卫生部行业专项课题（201402007）**通讯作者，E-mail：doczhangjun@126.com

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更新日期/Last Update: 2017-06-20