神经黏液样变性与精索静脉曲张相关阴囊疼痛相关性研究

The correlation between mucoid degeneration in the nerves and the pain in the scrotum region of varicocele patients

目的研究精索静脉曲张伴阴囊和(或)腹股沟区疼痛患者精索内神经是否存在病理学改变。方法选取2019年1月至6月南京大学医学院附属鼓楼医院收治的62例因精液问题拟行手术的原发性精索静脉曲张患者作为研究对象。根据患者是否伴有阴囊和(或)腹股沟区疼痛不适分为疼痛组(n=28)和非疼痛组(n=34)。搜集患者的基线资料,术中留取精索筋膜、精索内脂肪组织标本。显微镜观察标本内神经是否存在病理学改变。随访患者术后疼痛缓解、精液质量等情况。结果疼痛组中4例精索筋膜内神经存在黏液样变性改变;非疼痛组中未发现病变神经。病史对病变情况有显著影响(P<0.05,OR=1.163)。患者术后疼痛及精液质量均得到改善。结论伴有阴囊和(或)腹股沟区疼痛不适的部分精索静脉曲张患者,其精索筋膜内的神经存在黏液样变性。精索静脉曲张性的阴囊和(或)腹股沟区疼痛不适可能与精索筋膜内神经的病变有关,精索筋膜内神经的变性可能是精索静脉曲张疼痛的病因之一。

Objective To study whether there was a pathological change of nerve in the spermatic cord in the varicocele patients with pain in the scrotum and/or inguinal region.Methods 62 patients with primary varicocele who underwent surgery to improve semen quality from Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School between January 2019 and June 2019 were enrolled in the study as the research object.According to whether there was pain and discomfort in the scrotum and/or inguinal region of the patients,62 patients were divided into two groups,28 cases in the pain group and 34 cases in the non-pain group.General data of patients were collected,and the biopsy specimens of spermatic fascia and adipose tissue were collected.Microscopic examination was performed to observe the pathological changes of the nerves in the specimens.Postoperative pain relief and semen improvement were followed up.Results In the pain group,there was a change of mucoid degeneration in 4 cases of nerves within the spermatic fascia;in the non-pain group,no lesions were found in all specimens.Medical history has a significant influence on the condition of the lesion(P<0.05,OR=1.163).Postoperative pain and semen quality were improved.Conclusions In some varicocele patients with pain and discomfort in the scrotum and/or inguinal region,there is mucoid degeneration in the nerves within the spermatic fascia.The pain and discomfort in varicose scrotal scrotum and/or inguinal region may be related to the lesions of nerves in the spermatic fascia.The degeneration of the relevant nerves may be one of the causes of varicocele pain.