超声探查精索静脉走行与微创手术切口定位

Spermatic vein detection by color doppler ultrasound for minimally trauma varicocelectomy

目的探讨应用超声探查曲张的精索静脉在腹股沟走行的局部解剖关系，以设计精索静脉曲张高位结扎的体表微创切口定位的可行性。方法随机选择60例精索静脉曲张患者并与传统手术定位方法35例精索静脉曲张患者进行对照。改进方法采用彩色多普勒超声探查精索静脉在腹股沟管内的深浅走行，设计微创切口是以股动脉为体表标志，精索静脉穿行腹股沟管跨越股动脉形成的垂直交叉点，平行上移1cm为切口的起点，以此起点向外上方做一条与腹股沟韧带平行并呈30°夹角的约2．0cm长的切口，这个切口距传统的内环口定位略低1cm。同期传统手术是以耻骨节结与髂前上棘连线中点稍上方2．0cm处为起点，取与腹股沟韧带平行切口5cm。结果微创组60例患者手术切口平均2．1cm，手术时间平均22min，住院时间平均为3．5d。传统组手术切口平均5．5cm，手术时间平均48min，住院时间平均为6．5d。结论超声定位下微创切口入路精索静脉相对表浅，手术创口微小、操作简便、时间缩短、定位准确。

Objective In order to choose the best surgical approach for minimally trauma varicocelectomy color Doppler ultrasound（CDU） was used to detect the anatomic relationships of spermatic vein in groin. Methods Sixty varicocele patients were randomly selected. Their spermatic veins were examined by CDU which beginning from superficial inguinal ring,passing the crossing point of spermatic vein and femoral artery,and ending at the 3cm above the deep inguinal ring. The depths from skin to spermatic vein were measured and the relationships between spermatic vein and femoral artery were recorded. Results The average length of incision is 2. lcm and the average duration of operation is 22 minutes. The average depth from skin to spermatic vein was 1.1 cm, 1.55cm and 3.56cm respectively at the site of the superficial inguinal ring,the crossing point of spermatic vein and femoral artery,and the deep inguinal ring. Conclusion The best approach for minimally trauma varicocelectomy is at the crossing point of spermafie vein and femoral artery because here the spermatic vein is relative superficial and has merged into two or three vessels and the femoral artery can be easily touched by fingers.