显微镜下治疗胡桃夹现象合并左侧精索静脉曲张的临床诊疗体会

发布时间：2018-02-21 11:04

本文关键词： 胡桃夹现象精索静脉曲张显微镜精索静脉结扎术　出处：《中华男科学杂志》2017年08期 　论文类型：期刊论文

【摘要】：目的:探讨显微镜下治疗胡桃夹现象合并左侧精索静脉曲张(VC)的临床疗效。方法:回顾性分析2012年8月至2016年2月收治的31例胡桃夹现象合并左侧VC患者的临床资料,根据有无手术治疗及手术方式不同将其分为3组,11例行显微镜下左侧精索静脉结扎术(显微镜结扎组),11例行经腹股沟左侧精索静脉高位结扎术(高位结扎组),9例行保守治疗(保守治疗组)。比较3组患者治疗前和治疗后6个月的精液质量、精索静脉直径变化情况、睾丸体积变化及两组手术组患者的术后复发情况。所有患者随访6~24(15.3±5.4)个月。结果:显微镜结扎组和高位结扎组术后精液质量参数均较术前有明显改善(P0.05),保守治疗组精液质量参数较前明显下降(P0.05);显微镜结扎组左侧精索静脉直径及乏氏动作时精索静脉直径术后分别为(1.84±0.22)、(2.16±0.25)mm,高位结扎组分别为(2.15±0.43)、(2.44±0.27)mm,较术前明显变窄(P0.05),保守治疗组分别为(2.94±0.24)、(3.77±0.26)mm,较前明显变宽(P0.05)。3组患者左侧睾丸体积治疗后6个月分别为(10.27±1.18)、(9.96±1.72)、(10.48±2.05)ml,与治疗前比较无统计学差异(P0.05);显微镜结扎组术后复发率与高位结扎组比较无统计学差异(P0.05)。结论:血尿、蛋白尿等症状较轻的核桃夹现象合并左侧VC的患者可姑息性行精索静脉结扎术,可改善患者临床症状及提高精液质量,显微镜下治疗胡桃夹现象合并左侧VC是一种良好的手术方式。
[Abstract]:Objective: to investigate the clinical effect of microscopical treatment of varicocele with left varicocele. Methods: the clinical data of 31 patients with Nutcracker with left VC from August 2012 to February 2016 were analyzed retrospectively. According to the operative treatment and the different surgical methods, they were divided into 3 groups: 11 cases treated with left spermatic vein ligation under microscope (11 cases of high ligation of left spermatic vein via inguinal vein via inguinal ligation group) (9 cases of high ligation group treated by high ligation group). The semen quality of the three groups was compared before and 6 months after treatment. Changes in the diameter of spermatic veins, The changes of testicular volume and the recurrence of the patients in the two groups were followed up for 6 ~ 2415.3 卤5.4 months. Results: the semen quality parameters in the microscope ligation group and the high ligation group were significantly improved compared with those before operation (P 0.05), while in the conservative treatment group, the semen quality parameters were significantly improved. The semen quality parameters decreased significantly in the microscope ligation group, the diameter of the left spermatic vein in the microscope ligation group and the diameter of the spermatic vein in the Vale's movement after operation were 1.84 卤0.22 and 2.16 卤0.25 mm, respectively, in the high ligation group, 2.15 卤0.43, 2.44 卤0.27 mm, significantly narrower than those in the preoperative group, and in the conservative treatment group, respectively. The left testicular volume was 10.27 卤1.18 卤1.72 卤2.05 渭 ml in the left testicular volume group 6 months after treatment. There was no significant difference in the recurrence rate between the microscope ligation group and the high ligation group (P 0.050.Conclusion: hematuria, hematuria, and hyperligation) were not significantly different between the microscope group and the high ligation group. Patients with mild symptoms such as proteinuria combined with left VC could be treated with varicocele ligation with palliative spermatic vein ligation, which could improve clinical symptoms and improve semen quality. It is a good surgical method to treat walnut clamp with left VC under microscope.
【作者单位】：南京大学医学院附属鼓楼医院泌尿男科;
【基金】：国家自然科学基金资助(81571430)~~
【分类号】：R699

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