摘要：目的 探讨在腹腔镜Palomo术中使用吲哚菁绿(indocyanine green，ICG)辅助保留淋巴管的应用效果。方法 本研究为回顾性队列研究。选取2025年1月至2025年7月55例在首都医科大学附属首都儿童医学中心泌尿外科手术治疗的精索静脉曲张患儿，将患儿分成ICG辅助腹腔镜保留淋巴管的Palomo术组(ICG组，n＝24)和传统腹腔镜Palomo术组(control group，CG组，n＝31)。进一步按术前双侧睾丸体积差将患儿分成术前双侧睾丸体积差＞20%的ICG辅助腹腔镜保留淋巴管的Palomo术组(ICG-A组，n＝10)和术前双侧睾丸体积差＞20%的传统腹腔镜Palomo术组(CG-A组，n＝11)；按术前精索静脉内径将患儿分成术前精索静脉内径＞2.7 mm的ICG辅助腹腔镜保留淋巴管的Palomo术组(ICG-B组，n＝18)和术前精索静脉内径＞2.7 mm的传统腹腔镜Palomo术组(CG-B组，n＝18)。术后1、3、6个月复查超声，测量患侧精索静脉内径和双侧睾丸体积，判定术后有无睾丸鞘膜积液、睾丸萎缩和复发。比较ICG-A组和CG-A组在改善患侧睾丸体积方面的差异；比较ICG-B组和CG-B组在改善患侧精索静脉内径方面的差异。结果 两组患侧均为左侧，年龄和分级比较，差异均无统计学意义(P＝0.765，P＝0.619)。患儿均顺利完成手术。ICG组没有患儿在术中向睾丸内注射吲哚菁绿后发生过敏反应，淋巴管均在30s内显影，数量1~4根，白光模式下呈墨绿色，近红外光模式下呈绿色荧光。两组均无一例发生睾丸萎缩和复发，ICG组睾丸鞘膜积液发生率明显低于CG组(0/24比7/31，P＝0.015)。ICG-A组和CG-A组术前患侧睾丸体积分别为(3.55±2.16)cm³和(3.85±2.01)cm³，术后6个月患侧睾丸体积分别为(8.35±3.95)cm³和(8.05±3.39)cm³。两组间患儿患侧睾丸体积在术前和术后6个月比较，差异均无统计学意义(P＝0.740，P＝0.852)。与术前相比，术后6个月两组患儿患侧睾丸体积均有明显增长(P＜0.001)。ICG-B组和CG-B组术前患侧精索静脉内径分别为[3.25(3.00, 3.50)]mm和[3.60(3.25, 3.73)]mm，术后6个月患侧精索静脉内径分别为[1.90(1.70, 2.22)]mm和[1.80(1.60, 1.93)]mm。两组间患儿患侧精索静脉内径在术前和术后6个月比较，差异均无统计学意义(P＝0.097，P＝0.265)。与术前相比，术后6个月两组患儿患侧精索静脉内径均有明显缩小(P＜0.001)。结论 在腹腔镜Palomo术中使用吲哚菁绿辅助保留淋巴管是安全、有效的，可以显著减少睾丸鞘膜积液的发生。

Abstract: Objective To investigate the clinical effect of indocyanine green (ICG)-assisted lymphatic preservation during laparoscopic Palomo surgery. Methods 55 children with varicocele who underwent surgical treatment in the Department of Urology, Capital Center for Children's Health, Capital Medical University, from January 2025 to July 2025 were selected and divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group (ICG group, n=24) and a conventional laparoscopic Palomo surgery group (control group, CG group, n=31).According to the preoperative bilateral testicular volume difference, the children were further divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group with a preoperative bilateral testicular volume difference >20% (ICG-A group, n=10) and a conventional laparoscopic Palomo surgery group with a preoperative bilateral testicular volume difference >20% (CG-A group, n=11).According to the preoperative internal diameter of the spermatic vein, the children were divided into an ICG-assisted laparoscopic lymphatic-sparing Palomo surgery group with a preoperative spermatic vein internal diameter >2.7 mm (ICG-B group, n=18) and a conventional laparoscopic Palomo surgery group with a preoperative spermatic vein internal diameter >2.7 mm (CG-B group, n=18).Ultrasonography was performed at 1, 3, and 6 months after surgery to measure the internal diameter of the affected spermatic vein and bilateral testicular volumes, and to evaluate postoperative testicular hydrocele, testicular atrophy, and recurrence.The improvement in affected-side testicular volume was compared between the ICG-A and CG-A groups.The improvement in the internal diameter of the affected spermatic vein was compared between the ICG-B and CG-B groups. Results The affected side was the left side in all children in both groups.There were no statistically significant differences in age or grade between the two groups (P=0.765, P=0.619).No allergic reaction occurred after intraoperative intratesticular injection of ICG in the ICG group.The lymphatic vessels were visualized within 30 seconds, with 1 to 4 vessels observed; they appeared dark green under white-light mode and green fluorecence under near-infrared mode.No testicular atrophy or recurrence occurred in either group.The incidence of testicular hydrocele was significantly lower in the ICG group than in the CG group (0/24 vs. 7/31, P=0.015).The preoperative affected-side testicular volumes in the ICG-A and CG-A groups were (3.55±2.16)cm³ and (3.85±2.01)cm³, respectively, and the affected-side testicular volumes at 6 months after surgery were (8.35±3.95)cm³ and (8.05±3.39)cm³, respectively.There were no statistically significant differences in affected-side testicular volume between the two groups before surgery or at 6 months after surgery (P=0.740, P=0.852).Compared with the preoperative values, affected-side testicular volume increased significantly in both groups at 6 months after surgery (P < 0.001).The preoperative internal diameters of the affected spermatic vein in the ICG-B and CG-B groups were [3.25(3.00, 3.50)]mm and [3.60(3.25, 3.73)]mm, respectively, and the internal diameters of the affected spermatic vein at 6 months after surgery were [1.90(1.70, 2.22)]mm and [1.80(1.60, 1.93)]mm, respectively.There were no statistically significant differences in the internal diameter of the affected spermatic vein between the two groups before surgery or at 6 months after surgery (P=0.097, P=0.265).Compared with the preoperative values, the internal diameter of the affected spermatic vein decreased significantly in both groups at 6 months after surgery (P < 0.001). Conclusion ICG-assisted lymphatic preservation during laparoscopic Palomo surgery is safe and effective, and can significantly reduce the incidence of testicular hydrocele.