钳扎法在显微镜下腹股沟下精索静脉结扎术中的应用  

The Effect of Picking-ligation Method to Handle the Adhered Periarterial Vein in Microsurgical Subinguinal Varicocelectomy

作　　者：宫满成[1] 袁润强[1] Gong Mancheng;Yuan Runqiang(Department of Urology, The People’s Hospital of Zhongshan, Zhongshan 528403, China)

机构地区：[1]中山市人民医院泌尿外科,中山528403

出　　处：《中国微创外科杂志》2020年第8期713-716,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：中山市医学科研基金项目(2016J040)。

摘　　要：目的探讨显微镜下腹股沟下精索静脉结扎术中钳扎法处理睾丸动脉旁粘连静脉的安全性。方法2015年6月~2017年1月显微镜下腹股沟下精索静脉结扎术中采用钳扎法处理睾丸动脉旁粘连静脉(利用显微镊子将睾丸动脉旁粘连的静脉提起,利用4-0丝线在尽可能靠近睾丸动脉和粘连静脉的分界面结扎粘连的静脉),观察术后精索静脉曲张复发、术后阴囊水肿、精子改善及症状缓解等情况。结果与术前相比,术后患者精子浓度明显提高[(39.0±9.5)×10^6/ml vs.(22.4±8.1)×10^6/ml,t=9.189,P=0.000];术后患者精子前向运动率明显改善[(37.9±6.9)%vs.(23.3±10.3)%,t=20.787,P=0.000];正常精子百分比明显提升[(7.3±2.2)%vs.(3.1±2.0)%,t=9.715,P=0.000];术后患者阴囊疼痛明显减轻[(1.0±0.6)分vs.(5.6±0.8)分,t=-22.939,P=0.000]。52例术后随访6~24个月,平均18个月。术后超声检查无精索静脉曲张复发,无阴囊水肿,无睾丸萎缩。结论显微镜下腹股沟下精索静脉结扎术中采用钳扎法能安全有效地处理睾丸动脉旁粘连静脉。Objective To investigate the clinical effect of picking-ligation method in the treatment of the adhered periarterial vein in microsurgical subinguinal varicocelectomy.Methods In subinguinal varicocelectomy performed from June 2015 to January 2017,we handled the difficult-to-isolate periarterial vein with picking-ligation method(we picked up the adhered periarterial vein with microscopic tweezer and ligated it with 4-0 silk suture as near to the adjacent border between testicular artery and adherent vein as possible).We analyzed the incidence of recurrence,postoperative scrotal edema,sperm improvement and the symptom relief.Results As compared with that before surgery,the sperm concentration of postoperative patients significantly increased[(39.0±9.5)×10^6/ml vs.(22.4±8.1)×10^6/ml,t=9.189,P=0.000],the rate of sperm anterior motility was significantly improved[(37.9±6.9)%vs.(23.3±10.3)%,t=20.787,P=0.000],the percentage of normal sperm increased significantly[(7.3±2.2)%vs.(3.1±2.0)%,t=9.715,P=0.000],and the postoperative pain relieved significantly[(1.0±0.6)points vs.(5.6±0.8)points,t=-22.939,P=0.000].The 52 patients were followed up for 6-24 months,with an average of 18 months.Postoperative ultrasonography showed no recurrence of varicocele,scrotal edema or testicular atrophy.Conclusion Picking-ligation method is an effective and safe surgical technique in microsurgical subinguinal varicocelectomy to handle the adhered periarterial vein which is difficult to isolate and ligate.

关 键 词：不育 显微手术 钳扎法 精索静脉曲张 精索静脉结扎术 

分 类 号：R69[医药卫生—泌尿科学]