Laparoscopic lymphatic sparing varicocelectomy in adolescents
Laparoscopic lymphatic sparing varicocelectomy in adolescents
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DOI：
10.1016/j.juro.2008.03.064
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发表时间：
2008-07-01
影响因子：
6.6
通讯作者：
Misseri, Rosalia
中科院分区：
文献类型：
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作者：
Glassberg, Kenneth I.;Poon, Stephen A.;Misseri, Rosalia
目的：腹腔镜精索静脉曲张切除术与开放性Palomo修复术相似。这两种手术都涉及精索内动脉结扎，并且都与1%至3%的复发率和高达30%的鞘膜积液发生率相关。我们试图确定淋巴保存对鞘膜积液形成和成功的精索静脉曲张的影响。材料和方法：我们回顾性评估了191例平均年龄为15.2岁的患者接受腹腔镜精索静脉曲张切除术，并至少随访6个月。患者被分为两组-那些谁经历了淋巴保留程序和那些谁经历了非淋巴保留技术。复发/持续性，术后鞘膜积液形成和术后鞘膜积液需要手术或抽吸的发病率进行了analysed.Results：共174腹腔镜淋巴保留程序（132例，42双边）和88 nonlymphatic保留修复（59例，29双边）进行，平均随访26.1个月。淋巴保留手术与术后鞘膜积液发生率降低相关（3.4% vs 11.4%，p = 0.025）。在保留淋巴管（5侧，2.9%）与非保留淋巴管（4侧，4.5%）的精索静脉曲张切除术后需要再次手术的持续性或复发性精索静脉曲张的发生率无显著差异（p = 0.736）。结论：腹腔镜保留淋巴管的精索静脉曲张切除术优于开放式或腹腔镜Palomo修复术，不保留血管。术后鞘膜积液的发生率显著较低，尤其是那些需要手术干预的鞘膜积液，并且仍然保持较低的持续性/复发率。该手术尤其适用于双侧精索静脉曲张切除术。
Purpose: Laparoscopic varicocelectomy is similar to an open Palomo repair. Both procedures involve en masse ligation of the internal spermatic cord, and both are associated with a 1% to 3% incidence of recurrence and up to a 30% incidence of hydroceles. We sought to determine the impact of lymphatic preservation on hydrocele formation and the success of varicocelectomy.Materials and Methods: We retrospectively evaluated 191 patients with a mean age of 15.2 years who underwent laparoscopic varicocelectomy and at least 6 months of followup. Patients were divided into 2 groups-those who had undergone a lymphatic sparing procedure and those who had undergone a nonlymphatic sparing technique. The incidence of recurrence/persistence, postoperative hydrocele formation and postoperative hydrocele requiring surgery or aspiration was analyzed.Results: A total of 174 laparoscopic lymphatic sparing procedures (132 patients, 42 bilateral) and 88 nonlymphatic sparing repairs (59 patients, 29 bilateral) were performed, with a mean followup of 26.1 months. Lymphatic sparing surgery was associated with a decreased incidence of postoperative hydrocele (3.4% vs 11.4%, p = 0.025). There was no significant difference in incidence of persistent or recurrent varicocele requiring reoperation following lymphatic sparing (5 sides, 2.9%) vs nonlymphatic sparing (4 sides, 4.5%) varicocelectomy (p = 0.736).Conclusions: Laparoscopic lymphatic sparing varicocelectomy is preferable to an open or laparoscopic Palomo repair that does not preserve the lymphatics. It has a significantly lower incidence of postoperative hydroceles, especially those requiring surgical intervention, and still maintains a low incidence of persistence/recurrence. The procedure is especially advantageous for bilateral varicocelectomy.