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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (06) : 378 -382. doi: 10.3877/cma.j.issn.1674-3253.2019.06.005

所属专题： 经典病例； 文献；

病例研究

显微镜下小切口行精索静脉-腹壁下静脉转流术治疗胡桃夹综合征的临床疗效观察
廖国龙1, 唐嘉妮1, 李亚妹1, 马赫1, 严彬元1, 李璐婧1, 庞俊1,†()   
  1. 1. 518107　深圳，中山大学附属第七医院泌尿外科
  • 收稿日期:2019-05-06 出版日期:2019-12-01
  • 通信作者: 庞俊
  • 基金资助:
    深圳市光明区卫健局中医药科研项目(GM2019020021)

Clinical observation of microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome with small incision

Guolong Liao1, Jiani Tang1, Yamei Li1, He Ma1, Binyuan Yan1, Lujin Li1, Jun Pang1,†()   

  1. 1. Department of Urology, the Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen 518107, China
  • Received:2019-05-06 Published:2019-12-01
  • Corresponding author: Jun Pang
  • About author:
    Corresponding author: Pang Jun, Email:
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引用本文：

廖国龙, 唐嘉妮, 李亚妹, 马赫, 严彬元, 李璐婧, 庞俊. 显微镜下小切口行精索静脉-腹壁下静脉转流术治疗胡桃夹综合征的临床疗效观察[J]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(06): 378-382.

Guolong Liao, Jiani Tang, Yamei Li, He Ma, Binyuan Yan, Lujin Li, Jun Pang. Clinical observation of microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome with small incision[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(06): 378-382.

目的

观察显微镜下腹股沟小切口行精索静脉高位结扎及精索静脉-腹壁下静脉转流术治疗胡桃夹综合征的临床疗效，评估手术方法的可行性、安全性及有效性。

方法

选择我院门诊初诊左侧精索静脉曲张的患者，经阴囊彩超、肾静脉-泌尿系彩超、肾功能、尿常规及CT等检查确诊为胡桃夹综合征8例，腰硬联合麻醉下腹股沟小切口行显微精索静脉高位结扎术及精索静脉-腹壁下静脉转流术，术后随访6个月。

结果

8例患者手术均获得成功。手术切口2～3 cm。腰腹痛、阴囊坠胀不适等临床症状明显改善或消失。尿常规恢复正常。精子浓度和（a+b级）精子活力明显改善（P<0.05）。复查彩超提示所有患者精索静脉曲张均治愈。左侧精索静脉-腹壁下静脉吻合口血流通畅。腹主动脉前狭窄段左肾静脉峰值流速较术前明显变缓。肾门扩张段与腹主动脉前狭窄段左肾静脉管径的比值较术前明显变小（P<0.05）。

结论

显微镜下腹股沟小切口行精索静脉高位结扎术及精索静脉-腹壁下静脉转流术治疗胡桃夹综合征临床效果确切、操作相对简单、创伤小、安全性高，值得临床推广。

关键词: 精索静脉曲张, 胡桃夹综合征, 显微镜, 精索静脉-腹壁下静脉转流术
Objective

To observe the clinical efficacy of microsurgical ligation of spermatic vein and spermatic-inferior epigastric vein anastomosis in the treatment of nutcracker syndrome with a small incision and to evaluate the feasibility, safety and effectiveness of the surgical procedure.

Methods

In the outpatient department of our hospital, 8 patients with newly diagnosed left varicocele were diagnosed as nutcracker syndrome by scrotal ultrasound and renal vein color ultrasound evaluation, renal function, urine routine and CT examination. Microsurgical spermatic-inferior epigastric vein anastomosis with a small inguinal incision were performed simultaneous with high level ligation of spermatic vein after combined spinal and epidural anesthesia. The patients were followed up for 6 months.

Results

All the operations were successfully accomplished. Skin incisions were about 2-3 cm.The clinical symptoms such as waist, abdominal pain and scrotal bulging discomfort were significantly resolved or disappeared. Urine routine indicators returned to normal. Sperm concentration and (a+b) sperm motility were significantly improved (P<0.05). Postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. Smooth blood flow was seen in the left spermatic-inferior epigastric vein anastomotic. The diameters of the proximal left renal vein and the peak velocities in the aortomesenteric portion of the left renal vein were significantly decreased after surgery (P<0.05).

Conclusion

Microsurgical spermatic-inferior epigastric vein anastomosis with its advantages of safety, effectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of nutcracker syndrome.

Key words: Varicocele, Nutcracker syndrome, Microscope, Spermatic-inferior epigastric vein anastomosis
图3 左侧精索内静脉-腹壁下静脉吻合口血流通畅，血流方向：精索静脉→腹壁下静脉→髂外静脉
视频1 左侧精索静脉-腹壁下静脉转流术
表1 8例胡桃夹综合征患者转流术前与术后资料的比较（±s）
? 术前 术后6个月 P值
精液常规 ? ? ?
? 精子浓度（106/ml） 19.8±9.0 38.5±8.5 <0.05
? 精子活力（%） 38.9±8.8 64.5±9.8 <0.05
阴囊彩超 ? ? ?
? 左侧睾丸直径（mm） 19.6±4.8 20.8±5.4 >0.05
? 精索静脉内径（mm） 03.43±0.16 01.86±0.24 <0.05
左肾静脉彩超 ? ? ?
? D1（mm） 09.4±2.4 06.2±0.8 <0.001
? D2（mm） 01.6±0.3 01.8±0.6 >0.050
? D1/D2 06.4±0.8 02.7±0.5 <0.001
? PV1（cm/s） 105.2±28.6 068.0±15.8 <0.001
? PV2（cm/s） 19.6±4.7 18.7±6.4 >0.05
? PV1/PV2 05.4±0.8 03.2±0.5 <0.001
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