Operative safety and oncologic outcomes in rectal cancer based on the level of inferior mesenteric artery ligation: a stratified analysis of a large Korean cohort

PURPOSE: To compare high and low inferior mesenteric artery (IMA) ligation in a large number of patients, and investigate the short-term and long-term outcomes. METHODS: This retrospective study compared outcomes between high IMA ligation and low IMA ligation with dissection of lymph nodes (LNs) around the IMA origin. A total of 1,213 patients underwent elective low anterior resection with double-stapling anastomosis for stage I–III rectal cancer located ≥6 cm from the anal verge (835 patients underwent IMA ligation at the IMA origin; 378 patients underwent IMA ligation directly distal to the root of the left colic artery along with dissection of LNs around the IMA origin). RESULTS: There was no difference in anastomotic leakage rate between groups. The 2 groups did not significantly differ in intraoperative blood loss, perioperative complications, total number of harvested LNs, and metastatic IMA LNs. However, more metastatic LNs were harvested in the high-tie than in the low-tie group (1.3 ± 2.9 vs. 0.8 ± 1.9, P = 0.002), and the incidence of positive pathologic nodal status was higher in the high-tie group (37.9% vs. 28.6%, P = 0.001). The 5-year local recurrence-free and metastasis-free survival rates were similar between groups, as were the 5-year overall and cancer-specific survival rates. CONCLUSION: Low IMA ligation with dissection of LNs around the IMA origin showed no differences in anastomotic leakage rate compared with high IMA ligation, without affecting oncologic outcomes. High IMA ligation did not seem to increase the number of total harvested LNs, whereas the ratio of metastatic apical LNs were similar between groups.

Oncologic and Anastomotic Safety of Low Ligation of the Inferior Mesenteric Artery With Additional Lymph Node Retrieval: A Case-Control Study

PURPOSE: We assessed the oncologic and anastomotic benefits of low ligation of the inferior mesenteric artery (IMA) with additional lymph node (LN) retrieval. METHODS: We performed a retrospective case-control study between January 2011 and July 2015. All patients underwent curative resection of a primary sigmoid or rectal tumor. We excluded patients with distant metastases at the time of diagnosis. The case group included patients who underwent high ligation of the IMA (high group, HG). The control group included patients who underwent low ligation of the IMA with low group with additional LN retrieval (LGAL). Controls were identified by matching patients based on age (±5 years), sex, tumor location, and final histopathological stage. Finally, each group included 97 patients. RESULTS: Clinical characteristics did not significantly differ between groups. The mean number of additional harvested LN was 2.19 (range, 0–11), and one patient in the LGAL had a metastatic LN among the additional harvested LN. The overall morbidity was 22.7% in the HG and 30% in the LGAL (P = 0.257). Anastomotic leakage occurred in 14 patients (14.4%) in the HG and 5 patients (5.2%) in the LGAL (P = 0.030). The mean disease-free survival time in the HG was longer than that in the LGAL (P = 0.008). The mean overall survival (OS) time was 70.4 ± 1.3 months. The mean OS was 63.7 ± 1.6 months in the HG and 69.1 ± 2.6 months in the LGAL (P = 0.386). CONCLUSION: Low ligation of the IMA with additional LN retrieval is technically safe. However, the oncologic effect was better after high ligation of IMA.

Observation on the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in the treatment of infertility caused by varicocele / 国际外科学杂志

Objective To observe the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in treating infertility caused by varicocele.Methods Retrospective analysis of 49 cases of infertility caused by varicocele admitted to the Affiliated Hospital Xuzhou Medical University from February 2015 to November 2016,average age was 27.5 years,aged 20-50 years;according to simple random method divided into experimental group (n =20) and control group (n =29).Patients in the experimental group were treated with laparoscopic high ligation of spermatic vein and compound xuanju capsule.Patients in the control group were treated with high ligation of spermatic vein.Semen quality (sperm concentration,forward motor sperm rate,sperm survival rate),peripheral blood sex hormone (follicle stimulating hormone,luteinizing hormone testosterone) were compared between the two groups before and 3 months after surgery.Pregnancy rate of the spouse 1 year after surgery were compared between the two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data were compared by Chisquare test.Results Preoperative sperm concentration [(14.95 ± 2.35) million/ml vs (15.69 ± 3.35) million/ml,P=0.118],forward motor sperm rate [(24.35 ± 3.72)％ vs (25.10 ± 3.89)％,P =0.221],sperm survival rate [(27.90 ± 2.59) ％ vs (26.93 ± 3.20) ％,P =0.122] was not statistically significant between experimental group and control group.3 months after operation,sperm concentration [(23.45 ± 4.39) million/ml vs (20.07 ± 2.91) million/ml,P =0.001],forward motor sperm rate [(34.80 ± 3.56) ％ vs (31.62 ± 3.75) ％,P=0.001],sperm survival rate [(44.55 ± 4.29)％ vs (39.52 ± 4.49)％,P =0.001] was statistically significant between experimental group and control group.Preoperative follicle stimulating hormone [(8.97 ±0.64) IU/L vs (9.17 ± 0.96) IU/L,P =0.238] and luteinizing hormone [(6.75 ± 0.49) IU/L vs (6.64 ±0.37) IU/L,P =0.744],testosterone [(10.87 ± 1.66) nmol/L vs (9.98 ± 1.17) nmol/L,P =0.064] was not statistical significance between experimental group and control group.3 months after operation,Follicle stimulation.[(6.96 ± 0.66) IU/L vs (7.34 ± 0.77) IU/L,P =0.043],luteinizing hormone [(6.04 ± 0.39) IU/L vs (6.15 ± 0.38) IU/L,P =0.038],testosterone [(14.46 ± 1.30) nmol/L vs (12.23 ± 2.23) nmol/L,P =0.001] was statistically significant between experimental group and control group.Pregnancy rate of the spouse 1 year of the experimental group was higher than the control group [65.0％ (13/20) vs 48.3％ (14/29)],but it was not statistically significant between two groups (x2 =1.34,P =0.247).Conclusions Laparoscopic high ligation of spermatic vein combined with compound Xuanju capsule in the treatment of infertility caused by varicocele can significantly improve semen quality and sex hormone levels.From visual data,the natural pregnancy rate is also improved compared with the simple operation group.It is worthy of clinical recommendation.

Surgical consideration of pediatric inguinal hernia / 中国实用外科杂志

Children's pelvic and abdominal wall muscles have not yet matured. The inguinal canal is shorter(can be less than 1 cm), and the ratio of thickness of abdominal wall to length of inguinal canal is almost 1:1. The distance between the internal ring and the external ring is so close that only requires a high level of ligation at internal ring, lacking of repairing basis. As the growth and development of pelvis, the length of the inguinal canal will also increase. Generally, when the length is more than 3 cm, there is the basic conditions of inguinal hernia repair, therefor under the age of 14 with groin hernia, the patient only need to receive a high ligation of the sac to restore the length and slope of the inguinal canal.Laparoscopic surgery is also in accordance with the basic principle. Mesh repair in primary inguinal hernia in childhood is suspected of overtreatment, at least is academical controversal.

Observation on the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in the treatment of infertility caused by varicocele / 国际外科学杂志

Objective@#To observe the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in treating infertility caused by varicocele.@*Methods@#Retrospective analysis of 49 cases of infertility caused by varicocele admitted to the Affiliated Hospital Xuzhou Medical University from February 2015 to November 2016, average age was 27.5 years, aged 20-50 years; according to simple random method divided into experimental group (n=20) and control group (n=29). Patients in the experimental group were treated with laparoscopic high ligation of spermatic vein and compound xuanju capsule. Patients in the control group were treated with high ligation of spermatic vein. Semen quality (sperm concentration, forward motor sperm rate, sperm survival rate), peripheral blood sex hormone (follicle stimulating hormone, luteinizing hormone testosterone) were compared between the two groups before and 3 months after surgery. Pregnancy rate of the spouse 1 year after surgery were compared between the two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test.@*Results@#Preoperative sperm concentration [(14.95±2.35) million/ml vs (15.69±3.35) million/ml, P=0.118], forward motor sperm rate [(24.35±3.72)% vs (25.10±3.89)%, P=0.221], sperm survival rate [(27.90±2.59)% vs (26.93±3.20)%, P=0.122]was not statistically significant between experimental group and control group. 3 months after operation, sperm concentration [(23.45±4.39) million/ml vs (20.07±2.91) million/ml, P=0.001], forward motor sperm rate [(34.80±3.56)% vs (31.62±3.75)%, P=0.001], sperm survival rate [(44.55±4.29)% vs (39.52±4.49)%, P=0.001] was statistically significant between experimental group and control group. Preoperative follicle stimulating hormone [(8.97±0.64) IU/L vs (9.17±0.96) IU/L, P=0.238] and luteinizing hormone [(6.75±0.49) IU/L vs (6.64±0.37) IU/L, P=0.744], testosterone [(10.87±1.66) nmol/L vs (9.98±1.17) nmol/L, P=0.064] was not statistical significance between experimental group and control group. 3 months after operation, Follicle stimulation. [(6.96±0.66) IU/L vs (7.34±0.77) IU/L, P=0.043], luteinizing hormone [(6.04±0.39) IU/L vs (6.15±0.38) IU/L, P=0.038], testosterone [(14.46±1.30) nmol/L vs (12.23±2.23) nmol/L, P=0.001] was statistically significant between experimental group and control group. Pregnancy rate of the spouse 1 year of the experimental group was higher than the control group [65.0% (13/20) vs 48.3% (14/29)], but it was not statistically significant between two groups (χ2=1.34, P=0.247).@*Conclusions@#Laparoscopic high ligation of spermatic vein combined with compound Xuanju capsule in the treatment of infertility caused by varicocele can significantly improve semen quality and sex hormone levels. From visual data, the natural pregnancy rate is also improved compared with the simple operation group. It is worthy of clinical recommendation.

Evaluation on efficacy and safety of blood-letting tape used in lower extremity varicose vein operation / 重庆医学

Objective To investigate the efficacy and safety of exsanguination band used in the lower extremity varicose vein operation.Methods A total of 158 cases of lower extremities varicose veins in this hospital served as the research subjects.All cases underwent the high ligation of great saphenous vein combined with punctate stripping operation.Among them,117 cases intraoperatively used the exsanguination band for blocking the lower limb blood flow (observation group),41 cases did not use the exsanguination band (control group).Then the intraoperative bleeding volume,operation time,pain degree and postoperative complications were observed in the two groups.Results Compared with the control group,the operation time,intraoperative blood loss,hematoma score,prothrombin time (PT) and fibrinogen (FIB) in the observation group were significantly decreased (P＜0.05),while activated partial thrombin time (APTT) and thrombin time (TT) were significantly increased(P＜0.05).The lower limb blood flow occlusion time in the observation group was 45-62 min with an average of (46.68-5.53) min.The sensory score and pain score at postoperative 2 weeks had no statistical difference between the two groups (P＞0.05).No arterial abnormalities and no obvious ischemic injury were found in the injured limbs of 2 groups.Conclusion Applying the exsanguination band for transiently blocking the blood flow can effectively shorten the operation time,reduces the intraoperative bleeding amount and decreases the subcutaneous hematoma formation risk with high safety.

Single channel laparoscopic extraperitoneal high ligation treating pediatric inguinal hernia / 第二军医大学学报

Objective To explore the feasibility of single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia. Methods The clinical data of 350 patients with inguinal hernia, who underwent single channel laparoscopic extraperitoneal high ligation in our department from Jun. 2015 to May 2016, were analyzed retrospectively. The surgical methods, operation time and postoperative complications were analyzed. Results The surgery was completed successfully on 350 cases. The average operative time was (4.5±1.2) min in the unilateral inguinal hernia, and (8.0±1.2) min in the bilateral ones. All patients were discharged on the first day after surgery, and the average hospital stay was (2.6±0.8) days. No inguinal pain or scrotal hematoma occurred after surgery. During the follow-up of 6 months to 1 year, there were no complications such as hernia recurrence, line reaction or testicular atrophy. Conclusion Single channel laparoscopic extraperitoneal high ligation for pediatric inguinal hernia keeps the puncture needle in the same tunnel, which avoids the postoperative pain at the puncture point and reduces the line reaction. It is safe and feasible, and is worth recommending for clinical use.

Trans-umbilical single site double-ports laparoscopy hernia sac high ligation in children (102 cases) / 中国内镜杂志

Objective To explore the reliability, advantages and precautions of trans-umbilical single site double-ports laparoscopy hernia sac high ligation in children. Methods Retrospective analysis of the clinical data of 102 patients of trans-umbilical single site double-ports laparoscopy hernia sac high ligation from April 2015 to June 2016, then summarize the treatment process, method and experience. Results All 102 cases of children with inguinal hernia, 84 cases of unilateral, bilateral in 18 cases. Unilateral cases, found in 24 cases of lateral occult hernia. Operation time: one side (16.17 ± 8.23) min, bilateral (23.68 ± 9.72) min. All the patients were discharged after 1 d, and the incision was beautiful. There was no swelling in the scrotum or labia, no hematoma, no adhesive intestinal obstruction, and followed up from 6~20 months without recurrence. Conclusion It is safe, reliable and effective to treat inguinal hernia in children with trans-umbilical single site double-ports laparoscopy hernia sac high ligation. It has advantages such as beautiful incision, small trauma, quick recovery, low requirements on technology and equipment, easy to grasp.

Preliminary Application of Lauromacrogol in the Treatment of Varicose Veins of Lower Limb / 现代生物医学进展

Objective:To investigate the application value of lauromacrogol in the treatment of varicose veins of lower limb.Methods:The medical records of 75 patients (75 affected limbs) with varicosis of great saphenous vein of lower limbs confirmed between September 2013 and September 2015 were analyzed retrospectively.According to the treatment regimen,the patients were divided into two groups.Among them,33 cases (33 limbs) treated by ultrasound guided injection of foam sclerosing agent lauromacrogol were included in the lauromacrogol group while 42 cases (42 limbs) treated by high ligation of great saphenous vein combined with stripping were included in the operation group.The operation time,intraoperative blood loss,off-bed time,treatment costs and incidence of postoperative complications were recorded.Patients were followed up for 6 to 12 months after operation,and the recurrence rate was recorded.Results:The operation time,off-bed and length of hospital stay of the lauromacrogol group were shorter than those of the operation group;the intraoperative blood loss and hospitalization expenses were less than those of the operation group (P＜0.05);The incidence rates of subcutaneous hematoma and skin numbness in the lauromacrogol group were significantly lower than those in the operation group (P＜0.05);The 12-month recurrence rate in the lauromacrogol group (12.12％) was lower than that in the operation group (33.33％)(P＜0.05).Conclusion:Injection of foam sclerosing agent lauromacrogol is an alternative minimally invasive therapy for treating varicosis of great saphenous vein of lower limbs.

Laparoscopic extraperitoneal high ligation of the spermatic vein for the treatment of varicocele / 中华男科学杂志

Objective@#To investigate the effect of laparoscopic extraperitoneal (LSEP) high ligation of the spermatic vein in the treatment of varicocele.@*METHODS@#We retrospectively analyzed the clinical data about 80 cases of varieocele, 48 treated by LSEP and the other 32 by laparoscopic transabdominal retroperitoneal (LSTR) high ligation of the spermatic vein. We recorded the semen parameters before and at 1, 3 and 6 months after surgery, intraoperative blood loss, operation time, postoperative complications, time of gastrointestinal function recovery and rate of pregnancy, followed by comparison of the data obtained between the two groups of patients.@*RESULTS@#Semen parameters were remarkably improved in both the LSEP and LSTR groups of patients postoperatively as compared with the baseline (P 0.05). The intraoperative blood loss was less in the LSEP than in the LSTR group (［8.3 ± 5.2］ vs ［9.1 ± 6.1］ ml, P >0.05), the operation time was shorter in the former than in the latter (［38.27 ± 9.23］ vs ［43.46 ± 11.72］ min, P >0.05), and so was the time of gastrointestinal function recovery (［1.27 ± 0.26］ vs ［2.43 ± 0.41］ d, P 0.05).@*CONCLUSIONS@#Laparoscopic extraperitoneal high ligation of the spermatic vein is safe and effective and has the advantage of quick recovery in the treatment of varicocele.

Analysis of the sperm DNA fragmentation in different degrees of varicocele infertility patients after high ligation of the spermatic vein / 中国内镜杂志

Objective To analyze the sperm DNA fragmentation in different degrees of varicocele (VC) infertility patients after high ligation of the spermatic vein. Methods There were 57 patients with different degrees of VC infertility patients. 27 patients had been diagnosed with level two VC, and 30 patients had been diagnosed with level three VC. All patients' sperm DNA fragmentation index (DFI) were detected and calculated at preoperative one month and postoperative three months. Results 57 VC infertility patients were all suffered from laparoscopic high ligation of the spermatic vein on both sides. There was no statistically difference on preoperative sperm DFI between level two and level three patients (P > 0.05). All patients' sperm DFI were decreased after laparoscopic (P < 0.05), and level two VC infertility patients had significant greater progress than level three patients (P < 0.05). Conclusion Laparoscopic high ligation of the spermatic vein can effectively improve VC infertility patients sperm DFI. It would be better for level two VC infertility patients.

Effect of laparoscopic varicocele high ligation on the semen parameters of patients with unilateral varicocele associated infertility / 国际检验医学杂志

Objective To investigate the effect of laparoscopic varicocele high ligation on the semen parameters of patients with unilateral varicocele associated infertility.Methods A total of 56 cases of unilateral varicocele with infertility treated in our hospital from March 2014 to March 2016 were recruited into this study,who were all recepted laparoscopic high ligation.The content of lactic dehydrogenase isoenzyme X(LDH-X),semen fragmentation rate(DFI) and other seminal plasma were observed and compared before surgery and 3 months after surgery.Results The ratio of LDH-X in seminal plasma and whole sperm,DFI and LDH-X of seminal plasma before laparoscopic varicocele high ligation were significant higher than those after surgery,LDH-X of whole sperm was lower than that after surgery,the differences were significant(P<0.05).Sperm concentration,sperm motility,survivability of sperm,and sperm forward progression percentage before laparoscopic varicocele high ligation were significant lower than those after surgery.Conclusion The quality of semen,the content of LDH-X and sperm DNA integrity of unilateral varicocele with infertility could be improved by laparoscopic high ligation of the internal cord vein.

Application of Improved Micro-laparoscopic High Ligation in Pediatric Inguinal Hernia / 昆明医科大学学报

Objective To compare the treatment effects between improved micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation.Methods Retrospective analysis was conducted.A total of 200 pediatric patients diagnosed with inguinal hernia in our hospital from 2013 to 2014,ranging in age from 8 months to 14 years,were enrolled and divided into observational group and control group (n=100) The two groups received improved-micro-laparoscopic hernia sac high ligation and traditional hernia sac high ligation respectively.We recorded intraoperative blood loss,operative incision length and operation time during the operation,and hospitalization time,pain time and total cost after the operation.Recurrence rate and complication were followed up for 6 months.Treatment effects were compared between these two groups.Results Smaller incision length,less blood loss and postoperative pain,shorter operative time and hospitalization time and lower recurrence rate were found in observational group and they were of statistical significance (P＜0.05).Conclusion Improved-micro-laparoscopic hernia sac high ligation for pediatric inguinal hernia shows better treatment effect,lower recurrence rate and better prognosis and it is an ideal approach.

Clinical analysis of laparoscopic totally extraperitoneal hernia repair combined with high position ligation of spermatic vein / 中国内镜杂志

Objective To summarize the clinical experience of laparoscopic total extraperitoneal hernia repair (TEP) combined with varicocele ligation for treating inguinal hernia combining with varicocele (VC).Methods Clinical data of 22 patients of inguinal hernia complicated with varicocele from April 2011 to April 2016 was retrospectively analyzed. All the patients were treated by TEP combined with high ligation of spermatic vein. Then monitor and analyzed clinical indexes intra- and postoperatively.Results The mean operation time was (55.0 ± 9.0) min, mean intraoperative blood loss was (5.5 ± 2.8) ml, all patients can eat after anesthesia recovery and off-bed after staying in bed for 24 hours; all patients don’t need postoperative analgesia; only 1 case suffered seroma postoperative; the average hospitalization time was (4.7 ± 0.9) days; postoperative follow-up of 1 to 5 year without recurrence.Conclusion The surgical effect of TEP combined with varicocele ligation is confirmed with less invasive, faster postoperative recovery and achieving an obvious social and economical effect, it is worthy of deserving further clinical application.

Midterm Clinical Outcomes after Modified High Ligation and Segmental Stripping of Incompetent Small Saphenous Veins

BACKGROUND: The aim of this study was to evaluate the midterm clinical outcomes after modified high ligation and segmental stripping of small saphenous vein (SSV) varicosities. METHODS: Between January 2010 and March 2013, 62 patients (69 legs) with isolated primary small saphenous varicose veins were enrolled in this study. The outcomes measured were reflux in the remaining distal SSV, the recurrence of varicose veins, the improvement of preoperative symptoms, and the rate of postoperative complications. RESULTS: No major complications occurred. No instances of the recurrence of varicose veins at previous stripping sites were noted. Three legs (4.3%) showed reflux in the remaining distal small saphenous veins. The preoperative symptoms were found to have improved in 96.4% of the cases. CONCLUSION: In the absence of flush ligation of the saphenopopliteal junction, modified high ligation and segmental stripping of small saphenous vein varicosities with preoperative duplex marking is an effective treatment method for reducing postoperative complications and the recurrence of SSV incompetence.

Effects of interventional catheter electric coagulation combined with high ligation of the great saphenous vein on varicose veins of lower extremity / 中国综合临床

Objective To evaluate the clinical effect of interventional catheter electric coagulation combined with high ligation of the great saphenous vein on varicose veins of lower extremity.Methods The clinical characteristics of 86 patients (92 lower extremity) with varicose veins of the great saphenous vein were treated by interventional catheter electric coagulation combined with high dligation from April 2009 to May 2012 admitted in our hospital were retrospectively analyzed,and the effects of treatment and complication and patients' recovery were observed.Results The total effective ratio of all the 92 lesions of 86 patients was 100％,in which 88 lesions were curative and 4 lesions were effective.The average hospitalization duration was (3.2 ± 2.4) days,and patients were completely cured after 3-8 weeks of postoperation.The occurrence of complications for bumhurt were in 58 lesions,ecchymosis in 15 lesions and paralysis in 2 leisons.The average follow-up duration of all the patients was (21.6 ± 9.6) months,and no local recurrence and complication was found.Conclusion Interventional catheter electric coagulation combined with high ligation of the great saphenous vein is a safe,effective and convenient and minimal invasive therapy for Varicose veins of lower extremity.

Comparative study on effects of different treatments on inferior mesenteric artery in resection of rectal cancer / 国际外科学杂志

Objective To evaluate the clinical significance of low ligation and high ligation of inferior mesenteric artery (IMA) and lymph nodes dissection on radical resection for rectal cancer.Methods One hundred and fifty-six patients who were diagnosed rectal cancer in our hospital between May 2007 and May 2008 were divided into low ligation group (80 cases)and high ligation group (76 cases).The low ligation group was treated with low ligation of IMA and lymph nodes dissection,the high ligation group was cured by high ligation of IMA and lymph nodes dissection.cases.The IMA lymph nodes metastasis,number of lymph nodes,cancer recurernce rate,5-year survival rate,complication rate were compared and analyzed.Results The rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 15.0％ in the low ligation group,the rate of lymph nodes metastasis around the origin of inferior mesenteric artery was 14.5％ in the high ligation group,and the difference was not statistically significant (P ＞ 0.05).Compared two groups of postoperative recurrence rate,5-year survival rate,anastomotic leakage rate,sexual dysfunction rate and urinary retention rate,there was no significant differences (P ＞ 0.05).The intestinal function recovery time and low anterior resection syndrome incidence of the low ligation group were lower than the high ligation group,there were significant differences (P ＜ 0.05).Conclusions Low ligation of inferior mesenteric artery and lymph nodes dissection can achieve radical resection for rectal cancer.Compared with traditional high ligation of inferior mesenteric artery,there were no differences for patients on recurrence rate,5-year survival rate and complication rate.

Comparison research of endovenous laser combined with high ligation and traditional operation in treatment of great saphenous vein varicose / 中国医师进修杂志

Objective To investigate the efficacy of endovenous laser combined with high ligation and traditional operation in treatment of great saphenous vein varicose.Methods One hundred and fifty-six cases of great saphenous vein varicose were divided into endovenous laser combined with high ligation(observation group,78 cases)and traditional operation(control group,78 cases)by table of random digits.The incidence of postoperative recovery and complications between two groups were compared.Result The operation time,amount of bleeding in operation,incidence of affected limb hematoma in observation group were significantly lower than those in control group[(42±5)min vs.(64±8)min,(30±8)ml vs.(50±5)ml,5.13％(4/78)vs.11.54％(9/78),P＜0.05].There was no significant difference between two groups of the postoperative recovery incidence and saphenous nerve injury incidence(P＞0.05).There was no affected limb deep venous thrombosis and great saphenous vein recanalization 1 year after operation.Conclusion Compared with the traditional operation,endovenous laser combined with high ligation has the same clinical efficacy,but less operation time,less amount of bleeding in operation,and less complication.

The application of transumbilica single-port laparoscopic surgery in the treatment of bilateral varicocele / 中国综合临床

Objective To explore the clinical value of transumbilica single-port laparoscopic surgery in the treatment of bilateral varicocele.Methods From Jan. 2010 to Sep. 2010,42 patients with bilateral varicocele underwent laparoscopic high ligation of bilateral spermatic vein.Of these patients,20 were treated with transumbilica single-port laparoscopic surgery,22 with traditional laparoscopic surgery.The two groups of patients were compared for the parameters such as intraoperative blood loss,testicular artery preservation,operating time,time of activities after surgery,time of intestinal function recovery and hospitalization duration.The semen quality 1 year after the surgery was compared with that before treatment.At the out-patient re-examination at 1,3,6months and 1 year after the surgery,the incision,scrotum,spermatic cord,testis were checked for possible complications.The relief of discomfortness in the scrotum was also followed up.Results Both operation procedures were successful,without severe complications.In the single-port laparoscopic surgery produced blood lose ( [ 5 ± 1 ] ml vs.[ 5 ± 1 ] ml,t =- 0.452,P ＞ 0.05 ),the operating time ( [ 41 ± 7 ] min vs.[ 39 ± 3 ] min,t =0.686,P ＞ 0.05 ),postoperative intestinal function recovery time ( [ 11 + 1 ] h vs.[ 11 + 2 ] h,t =- 1.631,P ＞0.05 ) and postoperative hospital stay ( [ 3.1 + 0.7 ] d vs.[ 3.4 + 0.7 ] d,t =- 1.447,P ＞ 0.05 ) which were all comparable to that from conventional laparoscopic surgery.There was significant difference in the population using analgesics,single-port laparoscopic surgery vs.conventional laparoscopic surgery ( 1 case [ 5.0％ ] vs 7case [ 31.8％ ].The difference was statistically significant (x2 =4.886,P ＜ 0.05 ).The single-port laparoscopic surgery produced neglectable scar at the incision.All of the patients were questionaired for their satisfaction with the incision 1 year after the surgery.The difference was statistically significant (x2 =7.636,P ＜ 0.01 )Conclusion Single-port laparoscopic high ligation of bilateral spermatic vein produces comparable outcomes to that of conventional laparoscopic surgery,but it is a more microinvasive procedure producing good aesthetic appearance,representing the trend of laparoscopic technique.

Laparoscopic high selective ligation of spermatic veins for treatment of varicocele / 中华泌尿外科杂志

Objective To discuss the treatment choices of varicocele by laparoscopic. Methods Retrospective analysis clinical datas of 337 patients with primary varicocele above grade Ⅱ.All of them were treated by operation and followed-up,238 cases had scrotum pain.265 cases were infertility after married.History of diseases was between 1-13 years.249(197 patients with infertility)were treated with laparoscopic high selective ligation of spermatic veins,as Group A.88(68 patiets with infertility)were treated with laparoscopic cluster ligation,as Group B.The clinical data were compared. Results Three hundreds and thirty-seven cases were followed-up 2 years after operation.The operative times of two groups were(38.04±10.9)min、(19.04±7.5)min,the incidences of hydrocelewere 0.4%(1/249),11.3%(10/88);theincidences oftesticular atrophywere 0%(0/249),3.4%(3/88);the improving rates of semen quality in 3 months were 77.1%(192/249),62.5%(55/88);the spontaneous pregnant rates of his spouses in 2 years were 56.8%(112/197),39.7%(27/68).There were significant differences among the 2 groups(P<0.05).The recurrence rates were 5.6%(14/249),4.5%(4/88),there was no significant difference among the 2 groups(P>0.05). Conclusion Laparoscopic high selective ligation of spermatic veins in this study had less complications,higher improving rates of semen quality and pregnant rates.