显微镜下精索静脉结扎联合左精索静脉-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效果  

Effect of Microsurgical Varicocele Ligation Combined with Left Spermatic Vein Inferior Vena Cava Shunt in the Treatment of Secondary Varicocele in Nutcracker Syndrome

作　　者：南永浩 王瑞[1] 吕坤龙 郑涛[1] 张天标[1] NAN Yonghao;WANG Rui;L Kunlong;ZHENG Tao;ZHANG Tianbiao(Department of Andrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院男科,河南郑州450052

出　　处：《河南医学研究》2025年第3期421-424,共4页Henan Medical Research

基　　金：河南省医学科技攻关计划联合共建项目(2018020144)。

摘　　要：目的 评估显微镜下精索静脉结扎联合左精索内静脉-腹壁下静脉分流术治疗胡桃夹综合征(NCS)继发精索静脉曲张的效果。方法 选取2020年7月至2023年3月就诊于郑州大学第一附属医院男科的16例NCS继发精索静脉曲张患者。对比手术前后临床症状、多普勒超声结果等各项检查指标。结果 16例患者手术均成功,手术时间(104.69±40.80)min,住院时间(4.69±0.49)d。术后随访阴囊疼痛或坠胀不适消失,术后无切口感染、脂肪液化、睾丸萎缩等并发症。对比手术前后肾血管超声提示:腹主动脉与肠系膜上动脉(SMA)夹角处左肾静脉(LRV)流速(PV1)降低(P<0.01),LRV肾门处流速(PV2)差异无统计学意义(P>0.05);PV1/PV2降低(P<0.01);LRV肾门处内径差异无统计学意义(P>0.05),腹主动脉与SMA夹角处LRV内径增加(P<0.05),其比值降低(P<0.05)。结论 显微镜下精索静脉结扎联合左精索静脉-腹壁下静脉分流术是治疗NCS继发精索静脉曲张的安全、有效、可行、值得推广的手术方法。Objective To evaluate the curative effect of microsurgical varicocele ligation combined with left spermatic vein inferior vena cava shunt in the treatment of secondary varicocele in nutcracker syndrome(NCS).Methods A total of 16 patients with secondary varicocele of NCS who visited the Department of Andrology at the First Affiliated Hospital of Zhengzhou University from July 2020 to March 2023 were selected,and the clinical symptoms,Doppler ultrasound results,and other examination indicators before and after surgery were compared.Results All 16 patients underwent surgery successfully,with a surgical time of(104.69±40.80)minutes and an hospital stay of(4.69±0.49)days.Postoperative follow-up showed that the pain or swelling of the scrotum disappeared,and there were no postoperative complications such as incision infection,fat liquefaction,testicular.The renal vascular ultrasound before and after operation were compared,and it showed that the velocity(PV1)of left renal vein(LRV)at the angle between abdominal aorta and superior mesenteric artery(SMA)decreased(P<0.01),while the velocity of LRV at the renal hilum(PV2)had no statistical significance(P>0.05),PV1/PV2 decreased(P<0.01).The internal diameter of the LRV at the hilum of the kidney had no statistical significance(P>0.05),but the internal diameter of the LRV at the angle between the abdominal aorta and the SMA had increased(P<0.05),and its ratio had decreased(P<0.05).Conclusion Microsurgical varicocele ligation combined with left spermatic vein inferior vena cava shunt is a safe,effective,feasible and worth popularizing method for the treatment of secondary varicocele to NCS.

关 键 词：胡桃夹综合征 静脉吻合 精索静脉曲张 显微外科 

分 类 号：R699.8[医药卫生—泌尿科学]