显微镜下精索静脉结扎联合腹壁下静脉转流术治疗精索静脉曲张合并胡桃夹征7例报告  

Microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery for 7 cases of severe varicocele complicated with nutcracker syndrome

作　　者：石华 陈业辉 欧阳斌 黄亮亮 柳建明 张进祥 魏鸿霭 邓军洪 Shi Hua;Chen Yehui;Ouyang Bin;Huang Liangliang;Liu Jianming;Zhang Jingxiang;Wei Hongai;DengJunhong(Department of Andrology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China;Department of Urology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院华南理工大学附属第二医院男性专科,广州510180 [2]广州市第一人民医院华南理工大学附属第二医院泌尿外科,广州510180

出　　处：《国际医药卫生导报》2019年第10期1517-1520,共4页International Medicine and Health Guidance News

基　　金：广东省自然科学基金项目(2016A030313460,2015A030313730);广东省中医药局科研课题(20171192).

摘　　要：目的探讨显微镜下精索静脉结扎联合左腹壁下静脉转流术治疗重度精索静脉曲张(VC)合并胡桃夹征(NCS)的疗效。方法 分析2016年10月至2018年10月本院收治的7例重度精索静脉曲张合并胡桃夹征的复诊患者临床资料,术前采用彩色多普勒超声(CDFI)或CT确诊,采用显微镜下左侧精索静脉高位结扎联合左精索静脉腹壁下静脉转流术治疗,术后复查CDFI、尿常规、尿红细胞形态、尿肾脏功能测定及精液分析。本组患者随访4~24个月。比较患者手术前后4个月的临床症状,吻合口通畅情况,精索静脉直径变化、精液质量及术后复发情况。结果 7例患者成功完成手术。术后腰痛及阴囊坠胀不适等症状消失。血尿及蛋白尿均消失。本组4例予精液检查,2例精液质量参数[精子浓度和活力]较术前明显改善,2例术前精液检查正常患者复查正常。B超显示精索静脉无返流,无术后复发。结论 显微镜下精索静脉结扎联合左精索内静脉-腹壁下静脉转流术治疗重度VC合并胡桃夹征,操作简化,创伤小,恢复快,效果好,患者及家属容易接受,推荐临床使用。Objective To explore the clinical effect of microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery in the treatment of severe left varicocele (VC) complicated with nutcracker syndrome (NCS). Methods The clinical data of 7 cases of left VC complicated with NCS treated in our hospital from October, 2016 to October, 2018 by microscopic ligation were analyzed. They were confirmed by CDFI and CT before the operation, and were treated by microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery. After the operation, they were rechecked by CDFI and routine urianlysis, their urinary erythrocyte phases, kidney function, and semen parameters were detected. All the patients were followed up 4-24 months. The clinical symptoms, stoma patency, spermatic vein diameter, sperm quality, and postoperative recurrence rate were compared between before and 4 months after the operation. Results All the 7 patients had successful operation. After the operation, their waist pain, scrotal distention, hematuria, proteinuria, etc. disappeared. 4 cases took semen examination, and 2 were improved in sperm concentration and activity, and the other 2 were still normal. B ultrasound showed no reversed flow in venae spermatica. No recurrence occurred after the operation. Conclusion Microscopic spermatic vein ligation and internal spermatic vein-inferior epigastric vein bypass surgery can alleviate clinical symptoms, improve semen quality, mitigate damage to testicles, and protect renal function. It is recommended to treat VC complicated with NCS, with the merits of simplication, effectiveness, small wound, and early recovery.

关 键 词：精索静脉曲张 胡桃夹综合征 显微镜 精索静脉结扎术 左精索内静脉-腹壁下静脉转流术 

分 类 号：R699.8[医药卫生—泌尿科学]