精索静脉高位结扎+左精索内-腹壁下静脉分流/肾静脉减压术在青少年男性胡桃夹综合征并精索静脉曲张中的疗效  

Spermatic-inferior epigastric vein anastomosis in the treatment of nutcracker syndrome complciated with varicocele in male adolescents

作　　者：徐曦[1] 张嘉鹏[1] 谢伟杰[1] 张彩霞[1] 朱定军[1] 范新祥[1] 黄立[1] 于皓 董文[1] 刘皓[1] 姚友生[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广东广州510120

出　　处：《现代泌尿外科杂志》2018年第1期11-15,共5页Journal of Modern Urology

基　　金：逸仙培育项目(No.1320715001)

摘　　要：目的对比精索静脉高位结扎+左精索内-腹壁下静脉分流/肾静脉减压术与单纯精索静脉高位结扎术在青少年男性胡桃夹综合征并精索静脉曲张中的疗效。方法回顾性分析2002~2015年我院收治的52例确诊为胡桃夹综合征合并精索静脉曲张的男性患者的临床资料,根据治疗过程中术式不同将患者分为分流术组(即行精索静脉高位结扎+左精索内-腹壁下静脉分流/肾静脉减压术,33例),高位结扎组(行单纯精索静脉高位结扎,19例)。所有患者于术后复查彩色多普勒超声检测左肾静脉狭窄与扩张段的流速、直径以及其比值,并复查精液分析、尿蛋白及尿红细胞。结果中位随访时间为18个月。分流术组中,29例患者在术后1月蛋白尿、血尿全部消失(P均<0.001),除左肾静脉远端流速外,其余各检测指标与术前相比均有明显改善(P均<0.05);治疗12个月后,患者精液指标明显改善,1例(3.03%)患者精索静脉曲张复发;2例(6.06%)精索静脉和腹壁下静脉吻合口通畅欠佳。高位结扎组血尿、蛋白尿的发生率与术前相比无变化,其余各检测指标未见明显改善(P均>0.05);治疗12个月后,精液指标改善,1例患者精索静脉复发(5.26%);5例血尿、蛋白尿进行性加重予行补救分流术治疗后好转。结论精索内静脉高位结扎+左精索内静脉-腹壁下静脉分流术较单纯精索静脉高位结扎术在青少年男性胡桃夹综合征合并精索静脉曲张的治疗中更为有效,且较为安全。Objective To compare the curative effects of spermatic-inferior epigastric vein anastomosis and pure spermatic vein high ligation for nutcraker syndrome （NCS） in male adolescents. Methods The clinical data of 52 male NCS patients treated during 2002 and 2015 were retrospectively analyzed. According to different surgical approaches, the patients were divid- ed into spermatic-inferior epigastric vein anastomosis group （n = 33） and pure spermatic vein high ligation group （n = 19）. After operation, the flow speed, diameter of the strictured vein and dilated segment, and the ratio between them were checked with Doppler ultrasound. The semen,urine protein and urinary albumin were examined. Results During the median follow-up of 18 months,in the spermatic-inferior epigastric vein anastomosis group, hematuria and proteinuria disappeared in 29 cases in 1 month （P〈0. 001）; except for the left renal vein flow speed, other indexes were improved obviously （P〈0.05）; after 12 months,semen density and viability were significantly improved; varicocele relapsed in 1 case （3.03%）, and the anastomotic stoma of 2 cases （6.06%） were obstructed. In the pure spermatic vein high ligation group, the incidence of hematuria,proteinuria and other indexes remained unchanged （P〉0.05） ; after 12 months, the semen density and viability were improved; varico- cele relapsed in 1 case （5.26 %）, and hematuria and proteinuria progressed in 5 cases, which were relieved after treatment. Conclusion Spermatic-inferior epigastric vein anastomosis was more effective than pure spermatic vein high ligation in the treatment of nutcracker syndrome complciated with varicocele in male adolescents.

关 键 词：胡桃夹综合征 青少年 静脉曲张 左精索静脉 腹壁下静脉分流 

分 类 号：R699[医药卫生—泌尿科学]