不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的疗效分析  

Therapeutic effects of different surgical treatments on left varicocele caused by nutcracker syndrome

作　　者：张天标[1] 曹玲 孙洋洋[1] 郑涛[1] 张卫星[1] 王瑞[1] ZHANG Tian-biao;CAO Ling;SUN Yang-yang;ZHENG Tao;ZHANG Wei-xing;WANG Rui(Institute of Male,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052;School of Basic Medical Sciences,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院泌尿外科男科,河南郑州450052 [2]郑州大学基础医学院,河南郑州450001

出　　处：《现代泌尿外科杂志》2020年第2期143-146,共4页Journal of Modern Urology

摘　　要：目的探讨不同术式治疗胡桃夹综合征所致左侧精索静脉曲张的临床疗效。方法回顾性分析郑州大学第一附属医院在2015年7月至2018年9月期间诊治的胡桃夹综合征所致左侧精索静脉中重度曲张患者的临床资料。56例患者共分为3组,24例患者行显微镜下左侧精索静脉低位结扎术+精索外静脉剥离切除术为低位结扎组;19例患者行开放性左侧精索静脉高位结扎术为高位结扎组;13例患者左侧精索静脉中重度曲张并有血尿和/或蛋白尿,行腹腔镜下左肾静脉外支架固定术+生殖静脉结扎术,为血蛋白尿组。术后随访6~30个月,平均(11.5±6.5)月,患者于术前及术后6个月复查阴囊彩超及精液分析,对比精索静脉直径和精液恢复情况。结果①3组患者组内比较:精索静脉直径术后显著小于术前,精子浓度、精子活率术后显著高于术前,差异均有统计学意义(P均<0.01);组间比较:精子浓度3组间术前术后差异均无显著性统计学意义(P均>0.05);而精索静脉直径低位结扎组优于其他2组,精子活率的提高低位结扎组优于其他2组,差异均有统计学意义(P均<0.05)。②血蛋白尿组患者术后随访血尿、蛋白尿症状消失,左肾静脉受压状况明显改善,低位结扎组、高位结扎组左肾静脉受压状况无明显改善。结论显微镜下左侧精索静脉低位结扎术是治疗胡桃夹综合征所致左侧精索静脉中重度曲张的一种姑息、有效的手术方式。Objective To explore the clinical efficacy of different surgical treatments for left varicocele caused by nutcracker syndrome.Methods Clinical data of 56 cases of moderate and severe left varicocele caused by nutcracker syndrome treated in the First Hospital of Zhengzhou University,ur hospital during Jul.2015 and Sep.2018 were retrospectively analyzed.The patients were divided into 3 groups:low ligation group(n=24,treated with low ligation of left spermatic vein under microscope plus stripping of external spermatic vein),high ligation group(n=19,treated with open left spermatic vein high ligation),and hemoproteinuria group(n=13,patients complicated with hematuria and/or proteinuria,treated with laparoscopic left renal vein external stent fixation plus ligation of reproductive vein).The patients were followed up for 6 to 30 months,average(11.5±6.5)months.Before surgery and 6 months after surgery,scrotal ultrasound and semen analysis were conducted to compare the spermatic vein diameter and semen recovery.Results After surgery,the diameter of spermatic vein was significantly smaller,while the sperm concentration and sperm survival rate were significantly higher in all 3 groups(all P<0.01).There were no significant differences in sperm concentration among the 3 groups before and after operation(all P>0.05);the low ligation group had smaller spermatic vein diameter and higher sperm viability than the other 2 groups(all P<0.01).In the hemoproteinuria group,hematuria and proteinuria disappeared,and the left renal vein compression was obviously improved,but the other 2 groups had no significant improvement.Conclusion Low ligation of the left spermatic vein under microscope is a palliative and effective surgical method to treat moderate and severe left varicocele caused by nutcracker syndrome.

关 键 词：胡桃夹综合征 精索静脉曲张 精索静脉结扎术 显微镜手术 

分 类 号：R699[医药卫生—泌尿科学]