腹壁下静脉-精索静脉分流术治疗男性胡桃夹综合征不育患者的疗效观察  

Microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome associated varicocele in infertile men

作　　者：刘立民 那万里[2] 曲立成 Liu Limin;Na Wanli;Qu Licheng(Department of Urology,Jilin Central Hospital,Jilin 132011,China;Department of Urology,China-Japan Union Hospital of Jilin Uniersity,Changchun 130033,China;Centre for Reproductive Medicine,the First Affiliated Hospital of Jilin Uniersity,Changchun 130021,China)

机构地区：[1]吉林市中心医院泌尿外科,132011 [2]吉林大学中日联谊医院泌尿外科,长春130033 [3]吉林大学第一医院生殖医学中心,长春130021

出　　处：《中华腔镜泌尿外科杂志（电子版）》2019年第6期382-386,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：吉林省卫生厅项目(3D511BB03430)

摘　　要：目的探讨显微镜下腹壁下静脉-精索静脉分流术治疗男性胡桃夹综合征患者的疗效。方法我们收集了2015年9月至2018年3月,吉林大学中日联谊医院8例伴有胡桃夹综合征导致的精索静脉曲张的男性不育患者的临床资料。8例患者均为体型瘦高的男性青年,平均年龄为28.5岁,其中血尿患者6例,腰痛患者1例,全部患者精子质量低下。全部患者都接受了显微镜下腹壁下静脉-精索静脉分流术的治疗。比较术前及术后的左肾静脉峰值流速比(PV比)、精子平均数量及活率、术后自然受孕率。结果手术时间85~105 min,术后平均住院时间为(7±0.5)d。术后随访1年,血尿消失的患者5例(83.3%),1例腰痛的患者症状缓解。术后PV比值较术前显著降低(P<0.01)。术后3、6、12个月精子总数较术前显著提高(P<0.05)。术后3、6、12个月精子活率较术前显著提高(P<0.05)。75%的患者配偶(6/8)在术后自然受孕。结论显微镜下精索静脉-腹壁下静脉分流术治疗伴有胡桃夹综合征导致的精索静脉曲张男性不育患者是一种安全有效的手术方式。Objective To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome(NCS)-associated varicocele in infertile men. Methods We prospectively analyzed eight infertile men with NCS-associated varicocele between September 2015 and March 2018. All patients were tall young males, the average age was 28.5 years, 6 cases with hematuria, 1 cases with flank pain, all the patients showed poor sperm quality. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis. The peak flow velocity ratio before and after operation, the average number of sperm and living rate, the natural pregnancy rate after operation were compared between the two groups. Results The operation time was 85-105 min, and the mean postoperative hospital stay was(7.0±0.5) d. During 1-year follow-up, hematuria completely resolved in 83.3%(5/6) patients and flank pain resolved in the patient. The peak velocity ratio of postoperation significantly smaller than that of preoperation(P<0.01). The mean sperm count, respectively 3, 6, 12 months after operation was significantly higher than that of preoperation(P<0.05). The mean sperm motility, respectively 3, 6, 12 months after operation was significantly higher than that of preoperation(P<0.01). Overall, 75%(6/8) of spouses of patients went on to conceive naturally. Conclusion Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.

关 键 词：男性胡桃夹综合征 精液质量 吻合术 精索静脉曲张 

分 类 号：R69[医药卫生—泌尿科学]