显微镜辅助腹股沟下层次解剖精索静脉结扎术治疗精索静脉曲张的临床应用  

Clinical application of microscope-assisted subinguinal hierarchical dissection in the treatment of varicocele

作　　者：南玉奎[1] 戴新燕[1] 郭兰戈 姚礼忠 贾宏亮[1] 李九智[1] NAN Yukui;DAI Xinyan;GUO Lange;YAO Lizhong;JIA Hongliang;LI Jiuzhi(Urology Center,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院泌尿中心,新疆乌鲁木齐830001

出　　处：《现代泌尿外科杂志》2024年第11期956-958,共3页Journal of Modern Urology

基　　金：新疆维吾尔自治区适宜技术推广项目(No.SYTG-202007)。

摘　　要：目的探讨显微镜辅助腹股沟下层次解剖精索静脉结扎术治疗精索静脉曲张(VC)的临床应用效果,以期为临床参考。方法回顾性分析新疆维吾尔自治区人民医院泌尿中心于2021年7月—2022年6月收治的113例VC患者的临床资料,所有患者均采用显微镜辅助腹股沟下层次解剖精索静脉结扎术,分层隔离,记录术中结扎精索内、外静脉,保留精索内、外动脉以及淋巴管数量。结果113例患者中左侧VC 98例,双侧15例,平均年龄(28.7±6.0)岁,曲张程度:Ⅱ度44例,Ⅲ度69例。术中结扎的精索内静脉左侧(9.18±3.21)条、右侧(9.02±3.39)条,精索外静脉左侧(1.47±0.93)条、右侧(1.41±1.10)条;保留的精索内动脉左侧(2.03±1.07)条、右侧(1.97±0.99)条,精索外动脉左侧(1.42±0.50)条、右侧(1.40±0.50)条;左侧保留淋巴管(3.87±2.07)条、右侧(3.89±1.99)条。结论层次解剖可确保输精管及其脉管系的完整性,管状支撑有助于隔离输精管及其血管与精索内静脉束,避免遗漏细小静脉、损伤淋巴管,有助于初学者或经验较少的医生提高手术技巧。Objective To investigate the clinical application of microscope-assisted subinguinal hierarchical dissection in the treatment of varicocele(VC),so as to provide reference for clinicians.Methods The clinical data of 113 VC patients admitted to our hospital during Jul.2021 and Jun.2022 were retrospectively analyzed.All patients were treated with microscope-assisted hierarchical anatomical spermatic vein ligation under the external ring,with layered isolation.The number of intraoperative ligations of the internal spermatic veins and external spermatic vein,preserved arteries as well as the number of lymphatic vessels were recorded.Results Among the 13 patients with a mean age of(28.7±6.0)years,98 had left-side lesion and 15 had bilateral lesion.The degree of varicocele:degreeⅡin 44 cases and degreeⅢin 69 cases.Intraoperative ligation of the internal spermatic veins:(9.18±3.21)on the left side and(9.02±3.39)on the right side.Intraoperative ligation of the external spermatic veins:(1.47±0.93)on the left side and(1.41±1.10)on the right side.Preservation of the internal spermatic arteries:(2.03±1.07)on the left side,(1.97±0.99)on the right side.Preservation of the external spermatic arteries:(1.42±0.50)on the left side and(1.40±0.50)on the right side.Preservation of lymphatics:(3.87±2.07)on the left and(3.89±1.99)on the right.Conclusion Hierarchical dissection ensures the integrity of the vas deferens and its vascular system,and tubular isolation aids in intraoperative reference identification,avoid omission of tiny veins and injury to lymphatic vessels,which helps to improve the surgical skills of beginners or less experienced surgeons.

关 键 词：精索静脉曲张 显微镜辅助 层次解剖 

分 类 号：R697.24[医药卫生—泌尿科学]