Microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome associated varicocele in infertile men

doi:10.3877/cma.j.issn.1674-3253.2019.06.006

Abstract

Abstract:

Objective

To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome (NCS)-associated varicocele in infertile men.

Methods

We prospectively analyzed eight infertile men with NCS-associated varicocele between September 2015 and March 2018. All patients were tall young males, the average age was 28.5 years, 6 cases with hematuria, 1 cases with flank pain, all the patients showed poor sperm quality. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis. The peak flow velocity ratio before and after operation, the average number of sperm and living rate, the natural pregnancy rate after operation were compared between the two groups.

Results

The operation time was 85-105 min, and the mean postoperative hospital stay was (7.0±0.5) d. During 1-year follow-up, hematuria completely resolved in 83.3%(5/6) patients and flank pain resolved in the patient. The peak velocity ratio of postoperation significantly smaller than that of preoperation (P<0.01). The mean sperm count, respectively 3, 6, 12 months after operation was significantly higher than that of preoperation (P<0.05). The mean sperm motility, respectively 3, 6, 12 months after operation was significantly higher than that of preoperation (P<0.01). Overall, 75%(6/8) of spouses of patients went on to conceive naturally.

Conclusion

Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.

Key words: nutcracker syndrome (NCS), sperm quality, anastomosis, varicocele

Limin Liu, Wanli Na, Licheng Qu. Microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome associated varicocele in infertile men[J]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(06): 382-386.

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Figures/Tables 2

References 16

[1]	He Y, Wu Z, Chen S, et al. Nutcracker syndrome-how well do we know it?[J]. Urol, 2014, 83(1): 12-17.
[2]	徐曦，张嘉鹏，谢伟杰, 等. 精索静脉高位结扎+左精索内-腹壁下静脉分流/肾静脉减压术在青少年男性胡桃夹综合征并精索静脉曲张中的疗效[J]. 现代泌尿外科杂志, 2018, 23(1): 11-15.
[3]	张晓东，林锦蓉，张佐炳, 等. 影像学诊断胡桃夹综合征进展[J]. 中国医学影像技术, 2019, 35(6): 942-944.
[4]	Alaygut D, Bayram M, Soylu A, et al. Clinical course of children with nutcracker syndrome[J]. Urol, 2013, 82(3): 686-690.
[5]	Hohenfellner M, D' Elia G, Hampel C, et al. Transposition of the left renal vein for treatment of the nutcracker phenomenon: longterm follow-up[J]. Urol, 2002, 59(3): 354-357.
[6]	KurklinskyAK, Rooke T W. Nutcracker phenomenon and nutcracker syndrome[J]. Mayo Clin Proc, 2010, 85(6): 552-559.
[7]	Pastuszak AW, Wang R. Varicocele and testicular function[J]. Asian J Androl, 2015, 17(4): 659-667.
[8]	ÇAYAN S, S AHIN S, AKBAY E. Paternity rates and time to conception in adolescents with varicocele undergoing microsurgical varicocele repair vs observation only: A single institution experience with 408 Patients[J]. J Urol, 2017, 198(1): 195-201.
[9]	Gunka I, Navratil P, Lesko M, et al. Laparoscopic left renal vein transposition for nutcracker syndrome[J]. Ann Vase Surg, 2016, 31(209): 1-5.
[10]	陈国晓，张祥生，朱晓博, 等. 显微镜下分流术治疗精索静脉曲张合并"胡桃夹"综合征的临床研究[J]. 中华男科学杂志, 2017, 23(9): 798-803.
[11]	Dong W, Yao Y, Huang H, et al. Surgical management of nutcracker phenomenon presenting as left varicocelein adolescents: A novel approach[J]. J Pediatr Urol, 2014, 10(3): 424-429．
[12]	Xu D, Gao Y, Chen J, et al. Laparoscopic inferior mesentericgonadal vein bypass for the treatment of nutcracker syndrome[J]. J Vasc Surg, 2013, 57(5): 1429-1431.
[13]	Li H, Zhang MC, Jiang Y, et al. Microsurgical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men:a preliminary experience[J].Urol, 2014, 83(1): 94-99.
[14]	丁强红，刘涛，何灼彬, 等. 腹腔镜下淋巴管保留在精索静脉高位结扎术中的应用[J/CD]. 中华腔镜泌尿外科杂志(电子版)，2014, 8(6): 55-58.
[15]	陈良佑，朱再生，刘全启, 等. 显微外科曲张精索静脉结扎术对精索静脉曲张的疗效分析[J]. 中国性医学, 2013, 22(10): 69-72.
[16]	宋涛，王春杨，张磊. 显微外科与腹腔镜两种手术治疗精索静脉曲张的疗效及并发症的对比观察[J]. 中华男科学杂志, 2012, 18(4): 335-338.

?	PV1（cm/s）	PV2（cm/s）	PV比值
术前	151±45	13.6±2.2	12.3±2.3
术后	49±4	13.6±1.8	03.4±0.7
t值	13.15	1.653	7.514
P值	<0.001	0.102	<0.001

?	PV1（cm/s）	PV2（cm/s）	PV比值
术前	151±45	13.6±2.2	12.3±2.3
术后	49±4	13.6±1.8	03.4±0.7
t值	13.15	1.653	7.514
P值	<0.001	0.102	<0.001

组别	术前	术后3月	术后6月	术后12月
精子数量（10⁶/ml）	16±5	21±5	25.5±2.7	31±50
精子活率（%）	27±9	46±9	64±7	65±10

组别	术前	术后3月	术后6月	术后12月
精子数量（10⁶/ml）	16±5	21±5	25.5±2.7	31±50
精子活率（%）	27±9	46±9	64±7	65±10

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