探讨免气腹与CO₂气腹腹腔镜精索静脉高位结扎术的临床疗效。

回顾性分析2010年5月至2016年4月解放军71军医院68例双侧精索静脉曲张患者行腰硬联合麻醉或全麻下双侧精索静脉高位结扎术的临床资料，其中34例行腹壁悬吊式免气腹腹腔镜手术（免气腹组），34例行经腹CO₂气腹腹腔镜手术（气腹组）。观察症状和体征改变及并发症情况，比较2组手术时间、术后住院时间、肠道功能恢复时间；分别比较气腹组、免气腹组术前和术后9个月的精子密度、精子活动度。

2组患者手术均顺利完成，症状、体征均改善，无严重手术并发症。2组手术时间、术后住院时间、肠道功能恢复时间比较，差异均无统计学意义（P均＞0.05）；2组患者术后9个月精子密度与术前比较，差异均无统计学意义（P均＞0.05），术后9个月精子活动率均较术前增高［气腹组：（78.59±6.50）% vs（74.41±6.95）%，免气腹组：（75.88±7.47）% vs（68.71±7.43）%］，差异具有统计学意义（t=6.549，P=0.013；t=15.770，P＜0.001）。

2种微创术式均可准确结扎精索内静脉，疗效确切，切口美观，术后恢复较快。免气腹手术避免了CO₂气腹对呼吸、循环系统的影响，无气腹并发症，可采用椎管内麻醉，作为更经济的术式选择。

To evaluate the clinical efficacy and application value of gasless and gas laparoscopic surgery in the treatment of bilateral varicocele.

A retrospective analysis was performed on the clinical data of 68 patients with bilateral varicocele at the 71st Army Hospital of PLA from May 2010 to April 2016. Laparoscopic varicocele high ligation were performed on 68 patients, including 34 case who underwent gasless laparoscopic surgery accompanied by abdominal wall lifting (AWL) under combined spinal epidural anesthesia (CSEA), and 34 cases who underwent gas laparoscopic surgery under general anesthesia (GA). Changes in symptoms and signs and complications were recorded. Operative time, postoperative hospitalization time, and time to intestinal function recovery between the two groups were compared. Preoperative sperm concentration and sperm motility were compared with those at 9 months after surgery in the two groups.

All operations were performed successfully. The symptoms and signs were eased or disappeared after the operations. No serious complications occurred. Operative time, postoperative hospitalization time, and time to intestinal function recovery did not differ significantly between the two groups (P＞0.05). There was no significant difference between preoperative sperm concentration and sperm concentration at 9 months after surgery in the two groups (P＞0.05). The percentage of motile sperm at 9 months after surgery was significantly higher than that before operation [gas laparoscopy group: (78.59±6.50)% vs (74.41±6.95)%, t=6.549, P=0.013; gasless laparoscopy group: (75.88±7.47)% vs (68.71±7.43)%, t=15.770, P＜0.001].

Both gasless and gas laparoscopic surgery have the advantages of minimal invasiveness, and both are effective treatments for varicocele. Gasless laparoscopic surgery could avoid the adverse effects of pneumoperitoneum and complications related to pneumoperitoneum. CSEA as an alternative anesthesia method could have contributed to the reduction of patients' financial burden.