Lymphatic sparing laparoscopic varicocelectomy:: A microsurgical repair
Lymphatic sparing laparoscopic varicocelectomy:: A microsurgical repair
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DOI：
10.1097/01.ju.0000154357.72837.43
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发表时间：
2005-05-01
影响因子：
6.6
通讯作者：
Nov치k, K
中科院分区：
文献类型：
--
作者：
Kocvara, R;Dvoracek, J;Nov치k, K
目的：小儿精索静脉曲张切除术中淋巴管的分离会因鞘膜积液形成、睾丸内水肿引起的睾丸肥大和睾丸功能下降而变得复杂。为了预防这些并发症，我们在腹腔镜精索静脉曲张切除术中引入了显微外科淋巴保留剥离术。材料和方法：我们回顾性地比较了1999年4月至2002年12月期间104例接受显微腹腔镜手术治疗II至III级精索静脉曲张的男孩与1997年1月至2002年3月期间67例使用传统腹腔镜手术而不保留淋巴管的男孩的结果。1999.使用10倍至20倍的光学放大，淋巴管被确定为无色的管状结构，很容易分离和preserved.Results：平均随访17个月后，精索静脉曲张复发两组之间没有显着差异（6.7%比8.9%，P = 0.56）。显微手术修复后鞘膜积液形成和睾丸肥大的发生率显著降低（分别为1.9%和2.9%，传统组为17.9%和20.1%，p = 0.0003）。结论：在腹腔镜精索静脉曲张切除术中保留睾丸在技术上是可行的，并减少鞘膜积液的形成和睾丸肥大的发展。这种显微手术的改进是一个安全和有效的替代泌尿科医生熟练的重建腹腔镜。
Purpose: The division of lymphatic vessels during pediatric varicocelectomy is complicated by hydrocele formation, testicular hypertrophy due to intratesticular edema and decline in testicular function. To prevent these complications, we introduced a microsurgical lymphatic sparing dissection into laparoscopic varicocelectomy.Materials and Methods: We retrospectively compared outcomes in 104 boys who underwent microsurgical laparoscopic repair for grade II to III varicocele between April 1999 and December 2002 to a group of 67 boys operated on using conventional laparoscopy without lymphatic preservation between January 1997 and March 1999. Using 10x to 20x optical magnification, the lymphatic vessels were identified as colorless tubular structures that were easily separated and preserved.Results: After a mean followup of 17 months there was no significant difference in varicocele recurrence between the 2 groups (6.7% vs 8.9%, p = 0.56). Hydrocele formation and testicular hypertrophy occurred significantly less frequently after microsurgical repair (1.9% and 2.9%, respectively, vs 17.9% and 20.1% in the conventional group, p = 0.0003). No major complications were encountered.Conclusions: Preservation of lymphatics in laparoscopic varicocelectomy is technically feasible, and decreases hydrocele formation and the development of testicular hypertrophy. This microsurgical modification is a safe and efficacious alternative for urologists skilled in reconstructive laparoscopy.