Application and evaluation of microsurgical spermatic-inferior epigastric vein anastomosis in the treatment of nutcracker syndrome complicated with varicocele
CHEN Jianfan1, LAI Caiyong1, GUO Zexiong1, HAN Jian2, LI Mingzhu3, KONG Guoquan3, LI Yutong1, ZHUO Yumin1
1 Department of Urology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China; 2 Department of Vascular Surgery,the First Affiliated Hospital of Jinan University; 3 Department of Ultrasound,the First Affiliated Hospital of Jinan University
Abstract：Objective: To compare the curative effects of microsurgical spermatic-inferior epigastric vein anastomosis and microsurgical spermatic vein high ligation for varicocele (VC) complicated by nutcracker syndrome (NCS). Methods： We retrospectively analyzed the clinical data of 98 cases of VC treated by surgery in our hospital from 2015 to 2019. According to different surgical procedures, the patients were divided into microsurgical spermatic-inferior epigastric vein anastomosis group (n = 53) and microsurgical spermatic vein high ligation group (n = 45). Urine routine, semen routine, scrotal ultrasound and left renal vein (LRV) color ultrasound were examined in all of the patients before and after operation. Results： In the microsurgical spermatic-inferior epigastric vein anastomosis group, hematuria was cured in 18 of 23 cases (78.3%) (P < 0.001), while proteinuria disappeared in 78.9% (15/19) cases (P < 0.001). In the microsurgical spermatic vein high ligation group, the incidence of hematuria and proteinuria remained unchanged (P > 0.05). Semen density and viability were significantly improved in both two groups (P < 0.05). The indexes about NCS in the microsurgical spermatic-inferior epigastric vein anastomosis group, especially the LRV peak velocity and the mean peak velocities ratio in upright posture, were obviously ameliorated as compared with those preoperation (P < 0.001). Likewise, the indexes about NCS in the microsurgical spermatic-inferior epigastric vein anastomosis group were significantly better than in the microsurgical spermatic vein high ligation group (P ≤ 0.001). Conclusion： Microsurgical spermatic-inferior epigastric vein anastomosis was more effective than microsurgical spermatic vein high ligation in the treatment of NCS complicated with VC.
陈建帆, 赖彩永, 郭泽雄, 韩键, 黎明珠, 孔国权, 李宇同, 卓育敏. 显微镜下左精索-腹壁下静脉分流术在胡桃夹征并精索静脉曲张患者中的应用评价[J]. 微创泌尿外科杂志, 2021, 10(4): 251-256.
CHEN Jianfan, LAI Caiyong, GUO Zexiong, HAN Jian, LI Mingzhu, KONG Guoquan, LI Yutong, ZHUO Yumin. Application and evaluation of microsurgical spermatic-inferior epigastric vein anastomosis in the treatment of nutcracker syndrome complicated with varicocele. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2021, 10(4): 251-256.
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