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

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

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。

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 spermaticinferior 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.