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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
- 第三军医大学学报 2021年43卷第12期 页码：1162-1166
- 作者机构：
400010 重庆，重庆医科大学附属第二医院泌尿外科
- 作者简介：
[梁培禾，E-mail: lph1972@163.com LIANG Peihe, E-mail: lph1972@163.com
- 基金信息：第四批重庆市中青年医学高端后备人才项目;重庆市基础科学与前沿技术研究(CSTC2017jcyjAX0435);2019年重庆市留学人员回国创业创新支持计划
DOI：10.16016/j.1000-5404.202012164
中图分类号： R697.24; R698.2; R699.8收稿：2020-12-20，
修回：2021-01-19，
纸质出版：2021-06-30
- 稿件说明：
移动端阅览
陈衍霖, 梁培禾, 周志豪. 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[J]. 第三军医大学学报, 2021,43(12):1162-1166.
Yanlin CHEN, Peihe LIANG, Zhihao ZHOU. Efficacy of microscopic spermatic vein ligation in treatment of nutcracker syndrome with only left varicocele[J]. Journal of Third Military Medical University, 2021, 43(12): 1162-1166.
陈衍霖, 梁培禾, 周志豪. 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[J]. 第三军医大学学报, 2021,43(12):1162-1166. DOI： 10.16016/j.1000-5404.202012164.
Yanlin CHEN, Peihe LIANG, Zhihao ZHOU. Efficacy of microscopic spermatic vein ligation in treatment of nutcracker syndrome with only left varicocele[J]. Journal of Third Military Medical University, 2021, 43(12): 1162-1166. DOI： 10.16016/j.1000-5404.202012164.
摘要
目的
2
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
2
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
2
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(LRVD
1
)、LRV近肾门处内径(LRVD
2
)及LRVD
1
/LRVD
2
较术前差异无统计学意义(
P
>
0.05)。
结论
2
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。
Abstract
Objective
2
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
2
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
2
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
1
7 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
2
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.
关键词
Keywords
references
ANANTHAN K, ONIDA S, DAVIES A H. Nutcracker syndrome: an update on current diagnostic criteria and management guidelines[J]. Eur J Vasc Endovascular Surg, 2017, 53(6): 886-894. DOI: 10.1016/j.ejvs.2017.02.015.
CLARKE BG. Incidence of varicocele in normal men and among men of different ages[J]. JAMA, 1966, 198(10): 1121-1122. DOI: 10.1001/jama.1966.03110230137039.
GREENBERG S H, LIPSHULTZ L I, WEIN A J. Experience with 425 subfertile male patients[J]. J Urol, 1978, 119(4): 507-510. DOI: 10.1016/s0022-5347(17)57531-x.
LEWIS S E. What does a varicocele do to a man's fertility? There is much more than meets the eye[J]. Int Braz J Urol, 2021, 47(2): 284-286. DOI: 10.1590/s1677-5538.Ibju.2019.0827.1.
REDMON J B, DROBNIS E Z, SPARKS A, et al . Semen and reproductive hormone parameters in fertile men with and without varicocele[J ] . Andrologia, 2019, 51(10): e13407. DOI: 10.1111/and.13407.
ASAFU-ADJEI D, JUDGE C, DEIBERT C M, et al . Systematic review of the impact of varicocele grade on response to surgical management[J ] . J Urol, 2020, 203(1): 48-56. DOI: 10.1097/ju.0000000000000311.
WANG H, JI Z G. Microsurgery versus laparoscopic surgery for varicocele: a meta-analysis and systematic review of randomized controlled trials[J]. J Invest Surg, 2020, 33(1): 40-48. DOI: 10.1080/08941939.2018.1474979.
CLAVIJO R I, CARRASQUILLO R, RAMASAMY R. Varicoceles: prevalence and pathogenesis in adult men[J]. Fertil Steril, 2017, 108(3): 364-369. DOI: 10.1016/j.fertnstert.2017.06.036.
ERBEN Y, GLOVICZKI P, KALRA M, et al . Treatment of nutcracker syndrome with open and endovascular interventions[J ] . J Vasc Surg Venous Lymphat Disord, 2015, 3(4): 389-396. DOI: 10.1016/j.jvsv.2015.04.003.
CHAU A H, ABDUL-MUHSIN H, PENG X, et al . Robotic-assisted left renal vein transposition as a novel surgical technique for the treatment of renal nutcracker syndrome[J ] . J Vasc Surg Cases Innov Tech, 2018, 4(1): 31-34. DOI: 10.1016/j.jvscit.2017.09.008.
OKA R, KAMIYA N, SUGIURA K, et al . Nutcracker syndrome treated by endovascular stenting of the left renal vein[J ] . Nihon Hinyokika Gakkai Zasshi, 2013, 104(6): 716-719. DOI: 10.5980/jpnjurol.104.716.
GILMORE B, BENRASHID E, GEERSEN D, et al . Gonadal vein transposition is a safe and effective treatment of nutcracker syndrome[J ] . J Vasc Surg Venous Lymphat Disord, 2020, S2213-333X(20)30470-4. DOI: 10.1016/j.jvsv.2020.09.002.
MIRÓ I, SERRANO A, PÉREZ-ARDAVÍN J, et al . Eighteen years of experience with pediatric nutcracker syndrome: the importance of the conservative approach[J ] . J Pediatr Urol, 2020, 16(2): 218. e1-218. e6. DOI: 10.1016/j.jpurol.2019.12.003.
LI H, ZHANG M, JIANG Y, et al . Microsur gical spermatic-inferior epigastric vein anastomosis for treating nutcracker syndrome-associated varicocele in infertile men: a preliminary experience[J ] . Urology, 2014, 83(1): 94-99. DOI: 10.1016/j.urology.2013.08.050.
陈国晓, 张祥生, 朱晓博, 等. 显微镜下分流术治疗精索静脉曲张合并"胡桃夹"综合征的临床研究[J]. 中华男科学杂志, 2017, 23(9): 798-803. DOI: 10.13263/j.cnki.nja.2017.09.006.
CHEN G X, ZHANG X S, ZHU X B, et al . Microsurgical bypass for varicocele with nutcracker syndrome[J ] . Nation J Androl, 2017, 23(9): 798-803. DOI: 10.13263/j.cnki.nja.2017.09.006.
DONG W, YAO Y S, HUANG H, et al . Surgical management of nutcracker phenomenon presenting as left varicocele in adolescents: a novel approach[J ] . J Pediatr Urol,2014, 10(3): 424-429. DOI: 10.1016/j.jpurol.2013.09.019.
WANG J, XIA S J, LIU Z H, et al . Inguinal and subinguinal micro-varicocelectomy, the optimal surgical management of varicocele: a meta-analysis[J ] . Asian J Androl, 2015, 17(1): 74-80. DOI: 10.4103/1008-682x.136443.
BAAZEEM A, BELZILE E,CIAMPI A, et al . Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair[J ] . Eur Urol, 2011, 60(4): 796-808. DOI: 10.1016/j.eururo.2011.06.018.
ALIZADEH M, NASEBAKHT A, VALIZADEH R, et al . A preliminary evaluation of serum level of testosterone, LH, and FSH in patients with varicocele after varicocelectomy as a kidney-related disease[J ] . Ther Clin Risk Manag, 2018, 14: 1585-1590. DOI: 10.2147/tcrm.s161641.
MAHESHWARI A, MUNEER A, LUCKY M, et al . A review of varicocele treatment and fertility outcomes[J ] . Hum Fertil (Camb), 2020: 1-8. DOI: 10.1080/14647273. 2020.1785117.
KOHN T P, KOHN J R, PASTUSZAK A W. Varicocelectomy before assisted reproductive technology: are outcomes improved?[J]. Fertil Steril, 2017, 108(3): 385-391. DOI: 10.1016/j.fertnstert.2017.06.033.
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