显微镜下精索内静脉-腹壁下静脉分流术治疗胡桃夹综合征继发精索静脉曲张的疗效分析  

Effect of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome associated with varicocele

作　　者：陈策 巨育泉 宋涛[2] 郑超[1] 黄晓东[1] 景海波 苏画画 罗晓辉[1] CHEN Ce;JU Yuquan;SONG Tao;ZHENG Chao;HUANG Xiaodong;JING Haibo;SU Huahua;LUO Xiaohui(Department ofUrology,Central Hospital of Baoji,Baoji 721008,Shaanxi,China;Department of Andrology,Nanjing Drum Tower Hospital,the AffiliatedHospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China;Clinical Medicine,Xi′an Medical University,Xi′an710021,Shaanxi,China)

机构地区：[1]宝鸡市中心医院泌尿外科,陕西宝鸡721008 [2]南京大学医学院附属鼓楼医院男科,南京210008 [3]西安医学院临床医学院,西安710021

出　　处：《中国性科学》2022年第12期43-48,共6页Chinese Journal of Human Sexuality

基　　金：宝鸡市卫生医学科研项目(2021-007)。

摘　　要：目的评估显微镜下精索静脉结扎+精索内静脉-腹壁下静脉分流术治疗胡桃夹综合征(NCS)继发左侧精索静脉曲张(VC)的疗效。方法选取2019年8月至2021年10月在宝鸡市中心医院泌尿外科就诊的23例NCS继发左侧VC患者纳入研究并给予手术治疗,对比术前和术后6个月临床症状及各项检查指标。结果23例患者手术顺利,切口愈合良好,未见血肿及局部感染。左侧阴囊隐痛均消失,3例血尿、2例蛋白尿明显缓解,左侧VC未复发。左肾静脉(LRV)穿行腹主动脉与肠系膜上动脉夹角处流速(PV1)明显降低(P<0.05),穿行夹角前流速(PV2)无明显变化(P>0.05),PV1/PV2显著降低(P<0.05);LRV穿行夹角前内径(LRVD1)明显减小(P<0.05),穿行夹角处内径(LRVD2)无明显变化(P>0.05),LRVD1/LRVD2显著降低(P<0.05)。术后平均精子计数、精子总活力显著提高(P<0.05)。血清抑制素B(INH B)水平由术前(117.78±8.88)pg/mL提高至(149.96±9.00)pg/mL。左侧肾小球滤过率(GFR)由(40.91±3.94)mL/min提高至(44.83±3.59)mL/min。结论显微镜下腹壁下静脉分流术治疗NCS继发左侧VC可明显改善患者LRV高压及阴囊内环境。Objective To evaluate the therapeutic effectiveness of microscopic varicocelectomy(MV)and microsurgical sprematic spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome(NCS)associated with left varicocele in adolescents.Methods 23 patients with left side VC secondary to NCS treated in the Department of Urology,Central Hospital of Baoji from August 2019 to October 2021 were enrolled in the study and given surgical treatment.Clinical symptoms and various examination indexes were compared before and 6 months after surgery.Results Microsurgical spermatic-inferior epigastric vein anastomosis was successfully performed in all 23 cases.All incisions healed well and there were no complications such as hemotoma and local infection.All patients with dull ache of left scrotum were significantly relieved,3 patients with hematuresis and 2 patients with proteinuria were obviously eased.The left varicocele didn′t relapse in all patients.Velocity of the left renal vein(LRV)at the angle between the abdominal aorta and the superior mesenteric artery(PV1)decreased a lot(P<0.05);while there is no statistically significant difference in velocity of the LRV near the renal hilum(PV2)(P>0.05);the PV1/PV2 ratio was significantly reduced(P<0.05).Inner diameter of the LRV near the renal hilum(LRVD1)reduced a lot(P<0.05),while there is no statistically significant difference in inner diameter of the LRV at the angle(LRVD2),and LRVD1/LRVD2 decreased significantly(P<0.05).Compared with pre-operation,semen quality was significantly improved,with total sperm count and sperm motility increased a lot(P<0.05).Besides,serum inhibin B(INH B)increased from(117.78±8.88)pg/mL to(149.96±9.00)pg/mL,and left Glomerular filtration rate increased from(40.91±3.94)mL/min to(44.83±3.59)mL/min.Conclusions Microsurgical spermatic-inferior epigastric vein anastomosis is effective in the treatment of nutcracker syndrome associated with left varicocele,which can significantly relieve left renal venous hypertension and improve

关 键 词：胡桃夹综合征 精索静脉曲张 分流术 肾小球滤过率 

分 类 号：R697[医药卫生—泌尿科学]