不同术式治疗胡桃夹综合征继发左精索静脉曲张效果分析

Clinical observation of different surgical methods in treatment of left varicocele secondary to Nutcracker syndrome

目的探讨不同术式治疗胡桃夹综合征(NCS)继发左精索静脉曲张的临床效果。方法回顾性分析2016-08—2021-08郑州大学第一附属医院泌尿外科行左肾静脉(LRV)外支架固定术的60例NCS继发左精索静脉曲张的青少年患者的临床资料。按不同术式分为3组,各20例。A组行腔镜手术并联合左精索静脉高位结扎术,B组行腔镜手术联合开放左精索静脉高位结扎术,C组不处理左精索静脉曲张。比较3组患者的基线资料及临床效果。结果3组患者的基线资料以及增大腹主动脉与肠系膜上动脉间的夹角、降低血尿及蛋白尿的发生率差异无统计学意义(P>0.05);A组改善精子质量、减小精索静脉内径的效果均明显优于B组、C组,差异均有统计学意义(P<0.05)。结论对于NCS继发左精索静脉曲张患者,腔镜手术、开放手术,以及是否联合左精索静脉高位结扎术,均能增大腹主动脉与肠系膜上动脉间的夹角和降低血尿及降低蛋白尿发生率;但腔镜LRV外支架固定术联合左精索静脉高位结扎术在改善精子质量、减小精索静脉内径、降低精索静脉曲张复发率等方面,具有明显优势。

Objective To investigate the clinical effect of different surgical methods in treatment of left varicocele secondary to nutcracker syndrome.Methods The clinical data of 60 adolescent patients who underwent laparoscopic left renal external venous stenting in the First Affiliated Hospital of Zhengzhou University from August 2016 to August 2021 were retrospectively analyzed.According to the surgical methods,they were divided into laparoscopic high ligation group(group A,20 cases),open surgery group(group B,20 cases),and no surgery group(group C,20 cases).The baseline data and clinical outcomes of 3 groups were compared.Results Three groups of patients with baseline data and increase the Angle between the abdominal aorta and superior mesenteric artery,reduce the incidence of hematuria and proteinuria there was no statistically significant difference(P>0.05),but in improving sperm quality,reduce the spermatic vein diameter,group A was better than that of group B and group C,there is statistically significant difference(P<0.05).Conclusion For the surgical treatment of left varicocele secondary to nutcracker syndrome,different surgical methods can increase the Angle between the abdominal aorta and superior mesenteric artery,reduce the occurrence of hematuria and proteinuria,but improve the sperm quality,reduce the diameter of the varicocele,reduce the recurrence rate of varicocele,etc.Laparoscopic left renal vein external stent fixation combined with laparoscopic high ligation of left spermatic vein has obvious advantages and better comprehensive results.