精索血管的显微组织解剖及临床应用

Microanatomy of blood vessels in spermatic cords and its clinical implication

目的:外环下切口和腹股沟管切口精索静脉曲张显微外科结扎术均被推荐于治疗精索静脉曲张,但手术复杂度不同。本研究旨在了解两种手术切口的精索血管显微解剖结构。方法:选择外环下切口80例,腹股沟管切口20例,术中记录精索动脉、静脉及淋巴管数量;并从10例成人尸体取材精索,经组织染色,记录两种切口水平精索动静脉数量。结果:术中中静脉(2～5 mm)在腹股沟管切口有(1.80±0.83)条,外环下切口有(3.98±1.99)条,两者差异有显著性(t=-7.536,P<0.01);静脉总数腹股沟管切口为(6.40±1.67)条,外环下切口为(9.01±2.70)条,两者差异有显著性(t=-4.071,P<0.01)。两种手术切口的小静脉(≤2 mm)、大静脉(≥5 mm)、动脉和淋巴管数量差异无显著性。尸体研究数据:在外环下水平和腹股沟水平动静脉数量差异均无显著性。结论:虽然外环下水平精索静脉总数及中静脉数量均多于腹股沟管水平,但中静脉并不会加大手术难度,外环下切口不会较腹股沟切口操作更复杂。

Objective： Both microsurgical subinguinal varicocelectomy （MSIV） and microsurgical high inguinal varicocelectomy （MHIV） are recommended for the treatment of varicocele, but they differ in technical complexity. This study aimed to determine the microanatomy of spermatic blood vessels in the two surgical approaches. Methods ： We recorded the numbers of spermatic veins, arteries and lymphatics in 80 cases of MSIV and 20 cases of MHIV. We also examined the spermatic cords from 10 adult male cadavers by histological staining. Results ： The numbers of medium spermatic veins （ 2 - 5 mm in diameter） were 1.80±0.83 and 3.98±1. 99 in MHIV and MSIV, respectively, with significant difference between the two groups （t = -7. 536, P 〈 0. 01）, and the total num- bers of spermatic veins were 6.40±1.67 and 9.01±2.70, also with significant difference between the two （ t = - 4. 071, P 〈 0. 01）. However, there were no significant differences between MHIV and MSIV in the numbers of small spermatic veins （diameter ≤2 mm）, large spermatic veins （diameter ≥5 mm）, arteries and lymphatics, nor in the numbers of spermatic veins and arteries of the cadavers. Conclusion ： The total number of spermatic veins and the number of medium spermatic veins may be larger in MSIV than in MHIV, but the medium spermatic veins do not increase surgical difficuhy, and MSIV is not more complicated than MHIV.