左侧精索内静脉-腹壁浅静脉分流术在胡桃夹综合征相关精索静脉曲张中的疗效评价

doi:10.19558/j.cnki.10-1020/r.2021.01.006

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摘要 目的: 评估经腹股沟皮下环行左侧精索静脉-腹壁浅静脉分流术治疗胡桃夹综合征相关的精索静脉曲张的疗效。方法: 选取联勤保障部队第940医院2017年2月—2019年2月符合胡桃夹综合征合并精索静脉曲张诊断的12名男性患者纳入研究,患者均接受左侧精索静脉结扎术及左精索内静脉-腹壁浅静脉分流术。对比所有患者术前术后左肾静血流峰值、直径以及其比值、精子计数、精子活性、24 h尿蛋白定量及尿红细胞计数,并通过腹股沟彩超随访精索静脉曲张复发情况。结果: 患者术后直立位左肾静脉的最大血流峰值（PV1）从术前（87.7±38.3）cm/s降至（43.5±25.8）cm/s。术后左肾静脉的血流峰值（PV1）与仰卧位测量肾门处肾静脉的血流峰值（PV2）比值（PV1/PV2）平均比明显降低[（7.7±2.8) vs. (4.3±1.4),P=0.023]。术后患者24 h尿蛋白定量及尿红细胞计数降低,血尿和蛋白尿得到部分缓解。与术前精液质量相比,平均精子计数在术后6个月[（26.0±16.8)×10⁶/mL]和术后12个月[（29.6±18.3)×10⁶/mL]显著改善。术后6个月时精子活力显著提高（29.7±11.3）%,术后12个月达到（32.3±9.4）%。在12个月的随访期间,12例患者均未出现精索静脉曲张复发。2例患者发生轻度鞘膜积液,通过保守治疗缓解。随访结束时未出现睾丸萎缩、腹股沟疝、感染或其他严重并发症。结论: 经腹股沟皮下环行左侧精索静脉-腹壁浅静脉分流术在男性胡桃夹综合征合并精索静脉曲张的治疗中能明显改善患者左肾静脉血流动力学及相关症状,提高精液质量,安全有效。

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	罗国雄
	李富东
	康印东
	张斌
	常德辉

关键词 ：胡桃夹综合征, 分流术, 精索静脉曲张, 腹壁浅静脉

Abstract：Objective: corresponding author:To evaluate the therapeutic effectiveness of microsurgical spermatic-superficial epigastric vein anastomosis through subinguinal approach for the treatment of nutcracker syndrome associated with left varicocele in adolescents. Methods: Patients diagnosed with left varicocele in out hospital were given ultrasound evaluation of left renal vein from February 2017 to February 2019. Those patients that met the diagnostic criteria of nutcracker syndrome were enrolled in the study. A total of 12 adolescent patients diagnosed with nutcracker syndrome associated with varicocele were included in the study. The preoperative and postoperative parameters involving physical examination, measurements of ultrasonography, urinalysis, 24-h urinary protein quantification, and semen analysis test were included in the follow-up protocol. Results: Totally 12 patients underwent spermatic-superficial epigastric vein anastomosis. The mean peak velocities ratio in upright posture was significantly decreased after surgery （7.7 ± 2.8 vs. 4.3 ± 1.4, P = 0.023）. The hematuria and proteinuria in postoperative patients were partially relieved. The mean sperm count significantly increased at 6th month （[26.0 ± 16.8] × 10⁶/mL） and 12th month （[29.6 ± 18.3] × 10⁶/mL）, and the mean perm motility was also increased at 6th month （29.7% ± 11.3%） and at 12th month （32.3% ± 9.4%）. Mild hydrocele was founded in 2 patients and relieved with conservative management. No major complications occurred at the end of follow-up. Conclusion: Microsurgical spermatic-superficial epigastric vein anastomosis through subinguinal approach is both safe and effective to treat nutcracker syndrome associated with left varicocele.

Key words： nutcracker syndrome varicocele anastomosis bypass superficial epigastric vein

收稿日期: 2020-06-09

基金资助:甘肃省自然科学基金（18JR3RA406）

通讯作者: 常德辉,luo.guoxiong@foxmail.com

引用本文:

罗国雄, 李富东, 康印东, 张斌, 常德辉. 左侧精索内静脉-腹壁浅静脉分流术在胡桃夹综合征相关精索静脉曲张中的疗效评价[J]. 微创泌尿外科杂志, 2021, 10(1): 22-26.
LUO Guoxiong, LI Fudong, KANG Yindong, ZHANG Bin, CHANG Dehui. Microsurgical spermatic-superficial epigastric vein anastomosis to treat the nutcracker syndrome associated with left varicocele in adolescents. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(1): 22-26.

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