显微镜下精索静脉结扎术对胡桃夹综合征仅表现为左侧精索静脉曲张的疗效分析

Efficacy of microscopic spermatic vein ligation in treatment of nutcracker syndrome with only left varicocele

目的评估显微镜下精索静脉结扎手术治疗胡桃夹综合征(nutcracker syndrome, NCS)仅表现为中重度左侧精索静脉(left spermatic vein, LSV)曲张(varicocele, VC)的有效性和安全性。方法回顾性分析本院2016年2月至2020年8月收治的34例NCS所致中重度LSV曲张患者的临床资料,对比患者术前、术后临床症状及各项辅助检查结果。结果 34例患者均顺利完成显微镜下精索静脉结扎术,术前19例患者存在睾丸坠胀不适、疼痛,术后17例明显缓解。患者均未出现睾丸鞘膜积液、阴囊水肿等并发症。34例患者随访3~15个月,未见复发病例。患者术后3个月左侧精索静脉内径(left spermatic vein diameter, LSVD)、精子密度、每毫升前向运动精子数、血清总睾酮及卵泡刺激素(follicle-stimulating hormone, FSH)较术前均有明显改善(P<0.05);但精子活力、黄体生成素(luteinizing hormone, LH)、左肾静脉(left renal vein, LRV)在腹主动脉(abdominal aorta, AO)与肠系膜上动脉(superior mesenteric artery, SMA)夹角处流速(PV_(1))、LRV近肾门处流速(PV_(2))以及PV_(1)/PV_(2),LRV在AO与SMA夹角处内径(LRVD1)、LRV近肾门处内径(LRVD2)及LRVD_(1)/LRVD_(2)较术前差异无统计学意义(P>0.05)。结论显微镜下精索静脉结扎术治疗NCS仅表现为中重度LSV曲张安全有效,可以明显改善相关临床症状、提高精液质量,不会导致胡桃夹现象加重及出现NCS的其他相关临床表现。

Objective To evaluate the efficacy and safety of microscopic ligation of spermatic vein in the treatment of nutcracker syndrome(NCS) with only left spermatic vein(LSV) varicocele. Methods The clinical data of 34 patients with moderate and severe LSV varicocele caused by NCS who were admitted to our hospital from February 2016 to November 2020 were retrospectively analyzed, and the preoperative and postoperative clinical symptoms and examination results of the patients were evaluated and compared. Results Low-position ligation of LSV under microscope was successfully performed in all 34 cases. Of the 19 patients with preoperative discomfort and pain of swollen testicle, 17 were significantly relieved after the surgery. No complications such as testicular hydrocele and scrotal edema occurred in all the patients, and during the follow-up of 3-15 months, no recurrence was found. Among the patients, the left spermatic vein diameter(LSVD), sperm density, forward motility sperm count, total testosterone and follicle-stimulating hormone(FSH) were significantly improved 3 months after the surgery(P<0.05). By contrast, there were no significant differences between pre-and post-surgery(P>0.05) in sperm motility, luteinizing hormone(LH) and following ultrasonographic indicators: velocity of the left renal vein(LRV) at the angle between the abdominal aorta(AO) and the superior mesenteric artery(SMA)(PV_(1)), velocity of the LRV near the renal hilum(PV_(2)), PV_(1)/PV_(2);inner diameter of the LRV at the angle between the AO and SMA(LRVD_(1)), inner diameter of the LRV near the renal hilum(LRVD_(2)), and LRVD_(1)/LRVD_(2). Conclusion Microsurgical ligation of LSV is safe and effective in the treatment of moderate and severe left varicocele caused by NCS, which can significantly improve the clinical symptoms and semen quality, without aggravating the nutcracker phenomenon or causing other clinical manifestations of NCS.