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

doi:10.3877/cma.j.issn.1674-3253.2019.06.005

Abstract

Abstract:

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

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.

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References 14

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?		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

?		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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