5例显微镜下精索内静脉-腹壁下静脉端侧吻合分流术治疗精索静脉曲张合并胡桃夹现象的疗效分析  

Effect of microsurgical spermaticinferior epigastric vein end-to-side anastomosis for treating nutcracker syndrome associated varicocele:5 cases

作　　者：徐春璐 宋涛[1] 陈海[1] 戴玉田[1] XU Chunlu;SONG Tao;CHEN Hai;DAI Yutian(Department of Andrology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院男科,南京210008

出　　处：《中国性科学》2021年第9期15-18,共4页Chinese Journal of Human Sexuality

摘　　要：目的评估创新性的显微镜下精索内静脉-腹壁下静脉端侧吻合分流术治疗精索静脉曲张合胡桃夹现象的临床疗效。方法选取2020年1月至6月在南京大学医学院附属鼓楼医院男科行显微镜下精索内静脉-腹壁下静脉端侧吻合分流术的5例患者的临床资料进行回顾性分析,随访并复查彩超、尿常规、精液常规等资料。结果5例患者手术均取得成功,术后6个月复查,显示精索静脉曲张均治愈,精子总活力较术前明显改善,差异具有统计学意义(P<0.05)。5例阴囊疼痛不适患者症状均消失,1例镜下血尿和蛋白尿患者复测尿常规未见血尿、蛋白尿。5例患者均未出现明显并发症。结论创新性显微镜下精索内静脉-腹壁下静脉端侧吻合分流术表现出了良好的左侧精索静脉治疗效果,但对于左肾静脉受压的治疗效果不一,仅表现出一定的疗效。总体看,该术式仍可能因其吻合口更匹配,血流动力学破坏更小,而成为一种潜在、有效的治疗精索静脉曲张合并胡桃夹现象的手术方法。Objective To evaluate the clinical efficacy of innovative microsurgical spermaticinferior epigastric vein end-to-side anastomosis in the treatment of varicocele complicated with nutcracker.Methods 5 cases of end-to-side anastomosis of spermatic vein and inferior epigastric vein under microscope in the Department of Andrology of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January to June 2020 were retrospectively analyzed.The clinical data of the patients were collected,followed up and reviewed by color Doppler ultrasound,urine routine and semen routine.Results The operation was successful in all 5 patients.The varicocele was cured and the total sperm motility was significantly improved 6 months after operation(P<0.05).The symptoms of 5 patients with scrotal pain and discomfort disappeared.No hematuria and proteinuria were found in 1 patient with microscopic hematuria and proteinuria.No obvious complications occurred in 5 patients.Conclusions The innovative microscopical end-to-side anastomosis between the internal spermatic vein and the inferior epigastric vein has shown good results in the treatment of the left spermatic vein,but the treatment effect for the left renal vein compression is different,only showing a certain effect.Overall,this method may be a potential and effective surgical method for the treatment of varicocele and nutcracking phenomenon due to its the better matching of anastomotic stoma and less hemodynamic damage.

关 键 词：精索静脉曲张 胡桃夹现象 显微镜下精索内静脉-腹壁下静脉分流术 

分 类 号：R698[医药卫生—泌尿科学]