精索内静脉-腹壁下静脉逆行显微转流术治疗胡桃夹综合征的疗效观察

Internal spermatic vein inferior epigastricveinRetrograde microsurgery therapeutic effect of nutcracker syndrome

目的探讨显微镜左侧精索内静脉-腹壁下静脉逆行转流术及左精索静脉结扎术治疗胡桃夹综合征的手术治疗效果。方法回顾性分析2018年5月至2019年8月本院收治的55例胡桃夹综合征患者的临床资料,其中单纯左侧精索静脉曲张患者47例,双侧8例;中度曲张患者24例,重度31例。入院后均行超声检查确定精索内静脉的静脉最大内径,左肾静脉彩超明确左肾静脉受压现象并测定受压前后静脉内径及血流速度。所有患者均采用显微镜下将曲张的精索内静脉行高位结扎后,选择一根内径最大的精索内静脉与腹壁下静脉吻合的显微逆行转流手术方式。结果55例胡桃夹综合征患者手术均成功实施,平均手术时间(78.0±14.2)min,住院时间8 d。术后所有患者均未出现血肿、感染、血栓形成等并发症。3个月后复查彩超其中44例患者胡桃夹现象消失,30例临床症状消失,35例术前合并少弱精子症的患者中有25例精液分析恢复正常。结论左精索内静脉-腹壁下静脉逆行显微转流术联合左精索静脉结扎术治疗胡桃夹征术式简单、安全,手术效果确切,值得推广。

Objective To explore the effect of microscopical left spermatic vein-inferior epigastric vein retrograde shunt combined with left spermatic vein ligation in the treatment of nutcracker syndrome with left varicocele.Methods From May 2018 to August 2019,the clinical data of 55 patients with nutcracker syndrome and varicocele in our hospital were retrospectively analyzed,including 47 patients with simple left varicocele,8 patients with bilateral varicocele,24 patients with moderate varicocele,and 31 patients with severe varicocele.After admission,color Doppler ultrasound was used to determine the maximum diameter of varicocele,and color Doppler ultrasound was used to determine the compression phenomenon of left renal vein before and after compression,and the diameter and blood flow velocity were measured.All patients were treated with high ligation of varicose vein under microscope,and then a retrograde shunt of spermatic vein anastomosed with inferior epigastric vein was selected.Results 55 patients were operated successfully,the average operation time was(78.0±14.2)min and the hospital stay was 8 days.There were no complications such as hematoma,infection and thrombosis in all patients.3 months later,44 patients with nutcracker disappeared,30 cases of clinical symptoms disappeared,and 25 cases of semen analysis returned to normal in 35 cases of preoperative oligoasthenospermia.Conclusion Retrograde operation combined with ligation of left spermatic vein in the treatment of nutcracker sign and varicocele is simple,safe and effective,worthy of promotion.