左精索静脉曲张合并肾静脉性胡桃夹综合征行精索内静脉近心端-腹壁下静脉转流术治疗的临床观察  

Clinical observation on the proximal-inferior epigastric venous bypass of internal spermatic vein in the treatment of left varicocele complicated with renal vein nutcracker syndrome

作　　者：梁镇锋 邓志权 黄荏钊[1] 卢健军 卢世隆 张增强[1] 罗道升[1] LIANG Zhenfeng;DENG Zhiquan;HUANG Renzhao;LU Jianjun;LU Shilong;ZHANG Zengqiang;LUO Daosheng(Department of Urinary Surgery,Dongguan People's Hospital,Guangdong,Dongguan 523000,China)

机构地区：[1]广东省东莞市人民医院泌尿外科,广东东莞523000

出　　处：《中国医药科学》2021年第20期201-204,208,共5页China Medicine And Pharmacy

摘　　要：目的分析精索内静脉近心端-腹壁下静脉转流术治疗左精索静脉曲张伴肾静脉性胡桃夹综合征的价值。方法选取2017年2月至2020年2月东莞市人民医院收治的38例左精索静脉曲张伴肾静脉性胡桃夹综合征患者为研究对象,所有研究对象均采用精索内静脉近心端-腹壁下静脉转流术进行治疗。使用彩色多普勒超声分别记录患者术前、术后左肾静脉狭窄段以及扩张段流速、直径和比值。同时比较术前、术后1个月以及术后1年时患者左侧肾静脉远端流速、左侧肾静脉狭窄部位流速峰值、平均流速比、左侧肾静脉扩张部位最大内径、左侧肾静脉狭窄部位内径、扩张与狭窄部位内径比水平,并观察患者手术时间、术后住院时间以及术后并发症情况。结果38例患者平均手术时间(75.98±7.22)min,术后平均住院时间(7.11±1.82)d,术后全部患者左侧肾静脉压迫现象消失,无痛性阴囊蚯蚓状团块、阴囊坠胀、血尿、腰痛等症状均有改善,1例患者出现鞘膜积液,但症状较轻微,未实施特殊处理后积液自行吸收,所有患者术后未见伤口感染、睾丸萎缩、精索炎、精索鞘膜积液复发等并发症。术前与术后1个月时患者在左侧肾静脉远端流速、左侧肾静脉狭窄部位流速峰值、平均流速比、左侧肾静脉扩张部位最大内径以及左侧肾静脉狭窄部位内径方面比较,差异无统计学意义(P>0.05);术后1个月患者扩张与狭窄部位内径比小于手术前,差异有统计学意义(P<0.05);术前与术后1年时患者左侧肾静脉远端流速比较,差异无统计学意义(P>0.05);术后1年患者左侧肾静脉狭窄部位流速峰值、平均流速比、左侧肾静脉扩张部位最大内径及扩张与狭窄部位内径比均小于术前,左侧肾静脉狭窄部位内径大于术前,差异有统计学意义(P<0.05)。结论精索内静脉近心端-腹壁下静脉转流术治疗左精索静脉曲张伴肾静脉性胡�Objective To analyze the value of proximal-inferior epigastric venous bypass of internal spermatic vein in the treatment of left varicocele complicated with renal vein nutcracker syndrome.Methods A total of 38 patients with left varicocele complicated with renal vein nutcracker syndrome admitted to Dongguan People's Hospital from February 2017 to February 2020 were selected as study subjects,and all of them were treated with proximal-inferior epigastric venous bypass of internal spermatic vein.The flow velocity,diameter and ratio of the stenotic segment and the dilated segment of the left renal vein in the patients were recorded before and after operation using color Doppler ultrasound,respectively.The flow velocity of the distal left renal vein,peak flow velocity of the stenotic left renal vein,average flow velocity ratio,maximum internal diameter of the dilated left renal vein,internal diameter of the stenotic left renal vein,and the ratio of the dilated to stenotic internal diameter were also compared before,one month and one year after operation.In addition,the operating duration,postoperative length of stay,and postoperative complications were observed.Results The average operating duration was(75.98±7.22)min in 38 patients,and the average postoperative length of stay was(7.11±1.82)d.After operation,the compression of the left renal vein disappeared in all patients,and the symptoms of painless earthworm mass of scrotum,scrotal swelling,hematuria,and lumbago improved.There was one patient developing hydrocele with mild symptoms,and the effusion absorbed on its own without special treatment.No wound infection,testis atrophy,spermatitis,relapse of the spermatic cord hydrocele and other postoperative complications were observed in all patients.There were no statistically significant differences in terms of the flow velocity of the distal left renal vein,peak flow velocity of the stenotic left renal vein,average flow velocity ratio,maximum internal diameter of the dilated left renal vein and internal diameter o

关 键 词：腹壁下静脉转流术 近心端 胡桃夹综合征 肾静脉 左精索静脉曲张 

分 类 号：R699.8[医药卫生—泌尿科学]