结扎睾丸引带静脉对显微精索静脉曲张手术疗效的影响

目的:比较外环下显微精索静脉结扎术提出睾丸结扎引带静脉与不提出睾丸保留引带静脉的疗效及并发症。方法:回顾性总结163例精索静脉曲张患者术前及术后的临床资料,其中提出睾丸40例,不提出睾丸123例。比较不同手术方法在手术时间、术后并发症、复发率,以及术前、术后3个月精液质量的差异。结果:提出睾丸组手术时间(81.1±20.0)min,不提出睾丸组手术时间(62.3±9.6)min,两组间有统计学差异(P=0.041)。两组术后精子存活率、前向运动精子百分率、精子浓度以及1次射精总数均较术前显著改善(P0.05)。其中提出睾丸组Ⅲ度精索静脉曲张32例,不提出睾丸组Ⅲ度精索静脉曲张62例。两组间Ⅲ度曲张患者术前精子存活率、前向运动精子百分率、精子浓度、1次射精精子总数及术后3个月精子存活率、前向运动精子百分率、精子浓度、1次射精精子总数均无统计学差异(P均0.05)。提出睾丸组术后5例患者伴有阴囊水肿,不提出睾丸组术后2例患者伴有伤口感染。两组患者均无睾丸萎缩及精索静脉曲张复发。结论:外环下显微精索静脉结扎术提出睾丸结扎引带静脉与不提出睾丸保留引带静脉相比较,并没有更好的减少复发率和提高精液参数,反而更加延长手术时间以及引起阴囊水肿等并发症的发生。     

幼儿睾丸横过异位1例报告

患儿,男,1岁。主因右侧阴囊内无睾丸伴左侧腹股沟可复性肿物1年入院。查体：右侧阴囊发育欠佳,内无睾丸。右侧腹股沟内亦未及。左侧腹股沟内有一肿物,透光试验阴性,可还纳入腹。左侧阴囊发育良好,内可触及睾丸样组织两个,均约1．5cm×1．3cm×1．2cm大小。彩超示：左侧斜疝;左侧阴囊内双睾丸;右侧隐睾。初步诊断：右睾丸横过异位;左侧斜疝。经过术前准备,在全麻下行左侧疝囊高位结扎术,异位睾丸右侧阴囊内固定术。术中见两睾丸均有各自的精索和输精管,两睾丸膜状相连。与内侧睾丸相连的精索和输精管由膀胱前壁穿出内环口,考虑其为异位的右侧睾丸。     

钳扎法在显微镜下腹股沟下精索静脉结扎术中的应用

目的探讨显微镜下腹股沟下精索静脉结扎术中钳扎法处理睾丸动脉旁粘连静脉的安全性。方法 2015年6月～2017年1月显微镜下腹股沟下精索静脉结扎术中采用钳扎法处理睾丸动脉旁粘连静脉(利用显微镊子将睾丸动脉旁粘连的静脉提起,利用4-0丝线在尽可能靠近睾丸动脉和粘连静脉的分界面结扎粘连的静脉),观察术后精索静脉曲张复发、术后阴囊水肿、精子改善及症状缓解等情况。结果与术前相比,术后患者精子浓度明显提高[(39.0±9.5)×10~6/ml vs.(22.4±8.1)×10~6/ml,t=9.189,P=0.000];术后患者精子前向运动率明显改善[(37.9±6.9)%vs.(23.3±10.3)%,t=20.787,P=0.000];正常精子百分比明显提升[(7.3±2.2)%vs.(3.1±2.0)%,t=9.715,P=0.000];术后患者阴囊疼痛明显减轻[(1.0±0.6)分vs.(5.6±0.8)分,t=-22.939,P=0.000]。52例术后随访6～24个月,平均18个月。术后超声检查无精索静脉曲张复发,无阴囊水肿,无睾丸萎缩。结论显微镜下腹股沟下精索静脉结扎术中采用钳扎法能安全有效地处理睾丸动脉旁粘连静脉。     

腹腔镜下保留睾丸动脉的精索静脉高位结扎术

目的 探讨腹腔镜下保留睾丸动脉的精索静脉高位结扎术的应用价值.方法 2009年5月~2013年3月,对双侧精索静脉曲张21例,腹腔镜下行保留睾丸动脉的双侧精索静脉高位结扎术,术中使用冷器械,先于内侧分离出睾丸动脉,再整体游离并结扎血管束余部.结果 21例手术均顺利完成,无中转开放,术中出血〈10 ml,手术时间（45.2±14.5）min,术后6 h下床活动并恢复饮食,术后伤口疼痛轻微,均无须使用镇痛药物,术后3个月精子密度及活力提高13例（76%,13/17）,阴囊胀痛消失15例（93%,15/16）.随访3~50个月,平均25个月,无睾丸鞘膜积液、睾丸萎缩.结论 腹腔镜下单纯冷器械行保留睾丸动脉的精索静脉高位结扎术安全、可靠,具有微创的优势.     

腹股沟外环下切口显微精索静脉结扎术睾丸动脉系统的保护

目的:探讨腹股沟外环下切口显微精索静脉结扎术中睾丸动脉系统的情况,提高睾丸动脉保护水平。方法:2014年3月~2015年12月采用腹股沟外环下切口显微精索静脉结扎术治疗精索静曲张患者300例,年龄14~38岁,平均27.8岁,其中左侧188例,右侧25例,双侧87例,均经体检及精索静脉彩超确诊,并排除继发性精索静脉曲张;手术过程中记录动脉的数量,并按大小对其进行分类。结果:本组患者均保留睾丸动脉,其中腹股沟外环下切口睾丸动脉(精索内动脉)2条124例(41.3%),1条96例(32%),≥3条80例(26.7%);提睾肌动脉1条167例(55.6%),2条133例(44.4%);输精管动脉2条300例。睾丸动脉(精索内动脉)直径≥1mm而1.5mm者287例,1mm者13例;输精管动脉及提睾肌动脉直径均1mm。结论:腹股沟外环下切口显微精索静脉结扎术存在多条睾丸动脉的可能,应建立睾丸动脉系统保护的观念。     

神经外科显微镜在显微精索静脉曲张手术中的应用

目的 探讨神经外科显微镜在显微精索静脉曲张手术中的应用价值。方法 2018年7月～2021年11月对63例精索静脉曲张行外环口下显微精索静脉结扎术，在放大5～10倍神经外科显微镜下逐一结扎离断精索内静脉，保留精索内淋巴管和动脉，如遇曲张明显的精索外静脉及输精管静脉一并结扎，不拖出睾丸，引带静脉不予处理。结果 所有患者均做左侧，单侧手术时间60～110 min,(78.9±11.5)min。1例术中损伤到睾丸动脉，由于患者存在动脉分支，未做进一步处理。住院时间(3.8±0.6)d,住院费用(4006.36±236.56)元。2例出现阴囊水肿，术后2周左右消失。术后1年复查精液常规，精子浓度、精子数、正常形态精子率、精子前向运动率、配偶自然怀孕率均较术前明显升高(P<0.05);术后1年DNA碎片率、阴囊疼痛评分、精索静脉内径较术前明显降低(P<0.05)。63例术后随访1年，复查彩超未发生睾丸萎缩、睾丸鞘膜积液等并发症，1例精索静脉曲张复发。结论 神经外科显微镜下精索静脉结扎术可以较彻底结扎曲张的静脉，保护动脉及淋巴管，顺利完成手术。     

Ⅲ度精索静脉曲张患者显微结扎术后生精功能的变化

目的：研究Ⅲ度精索静脉曲张显微结扎术后生精功能的变化,以探讨手术的价值.方法：选择Ⅲ度精索静脉曲张并男性不育患者118例,观察其显微结扎术前后睾丸体积、精子密度、活率、形态、血清卵泡刺激素（FSH）、睾酮（T）及抑制素B浓度的变化.结果：患者手术6个月后的左侧睾丸体积（P〈0.05）、精子密度（P〈0.01）及活率（P〈0.05）均明显提高,血清FSH水平明显降低（P〈0.05）,T（P〈0.01）及抑制素B（P〈0.05）水平明显提高.而睾丸体积及精子形态无显著变化.结论：显微结扎术能改善Ⅲ度精索静脉曲张患者的生精功能.     

睾丸横过异位二例报告

本组2例,年龄分别为17及15个月,均以右侧腹股沟斜疝、左侧隐睾收入院.体检左侧阴囊发育不良,左侧腹股沟及阴囊均未触及睾丸,右侧腹股沟斜疝,右侧阴囊可触及正常大小睾丸,B超示左侧腹股沟及阴囊未探及睾丸,右侧睾丸未见异常.因术前检查均未发现左侧睾丸,2例均采用腹腔镜探查,术中见右侧腹股沟管内环处有一睾丸,其血管供应来自左侧精索内血管,与位于右侧阴囊的右睾丸呈上下排列,2个睾丸体积正常,分别有各自的精索血管及输精管,2条精索靠膜性组织粘连,睾丸与附睾解剖形态正常,异位的睾丸未见引带,术中行右侧疝环高位结扎,松解游离异位睾丸的精索至足够长,将左侧睾丸固定于左侧阴囊内.术后分别随访7、15个月,疗效满意.     

肠粘连松解术在腹腔镜精索静脉高位结扎术中应用的研究

目的:研究肠粘连松解术在腹腔镜精索静脉高住结扎术中的应用及临床意义.方法:对以下腹部坠胀不适症状为主要就诊原因的194例精索静脉曲张患者进行研究.194例患者均采用腹腔镜行精索静脉高位结扎术,术中腹腔镜直视下发现其中168例患者伴有下腹部肺粘连.采用随机对照性研究,将168例患者随机分为二组,A组75例,单纯行腹腔镜精索静脉高住结扎术.B组93例,行腹腔镜精索静脉高位结扎术+肠粘连松解术,所有患者术前均经B起证实为精索静脉曲张.术前记录患者精索静脉曲张程度,并记录患者下腹疼痛及坠胀不适情况、阴囊坠胀及阴囊潮湿等症状.术中腹腔镜直视下记录患者腹腔肠粘连情况.术后1个月、3个月、6个月分别随访一次,观察患者相应症状改善情况.结果:A、B两组共168例怠者均顺利完成手术.术后2～3天出院,无手术并发症发生.术后第1、3、6个月随访,A、B两组在阴囊坠胀不适,睾丸疼痛、阴囊潮湿等症状的消除缓解上均有明显改善,两组无明显差异;在下腹疼痛、坠胀不适等症状的缓解消除上,两组有明显差异,B组明显优于A组.结论:对于精索静脉曲张的患者,如合并下腹疼痛、坠胀不适等症状,应考虑同时存在肠粘连的可能.行腹腔镜精索静脉高位结扎术时,可同时行肠粘连松解术,对于下度疼痛、坠胀不适等症状的缓解和消除有明显效果.     

精素静脉曲张性慢性睾丸痛的显微外科治疗

目的 探讨精索静脉曲张性慢性睾丸痛的显微外科治疗的疗效和安全性. 方法 分析2010年9月至2012年6月期间收治的37例精索静脉曲张性慢性睾丸痛患者的临床资料,表现为阴囊坠胀不适、隐痛和钝痛;17例合并不育或少弱精症.采用腹股沟下显微精索静脉结扎术.术后每3个月复查精液进行疼痛评分和复查精液常规.每6个月行B超检查. 结果 术后随访12个月,睾丸疼痛完全消失32例,明显减轻4例,无效1例.未见复发、睾丸萎缩和鞘膜积液发生. 结论 显微外科技术治疗精索静脉曲张性慢性睾丸痛微创、安全和有效.     

Microanatomy of the spermatic cords during microsurgical inguinal varicocelectomy: initial experience in Asian men

The microanatomy of the inguinal spermatic cords has never been reported in Asia. The purpose of this study was to describe the number and relationship of the veins, arteries and lymphatics in the spermatic cord and to clarify the location of the vas deferens in Asian men. Fifty-one patients receiving 79 primary microsurgical varicocelectomies performed by a single surgeon from April 2011 to July 2012 were studied. The number of internal and external spermatic veins, testicular arteries and lymphatic channels preserved during the inguinal microsurgical varicocelectomy were recorded. The relationship between the right and left vascular anatomy during bilateral varicocelectomies was evaluated. The data showed that mean numbers of 1.5±0.9 arteries, 5.6±2.2 spermatic veins and 3.6±1.9 lymphatics were identified during the repairs. The internal spermatic arteries were surrounded by a dense complex of adherent veins in 81.2% of the cases. The external spermatic vein or veins were found in 60.8% of the cases. The vas deferens may be contained within the internal spermatic fascia. The results suggest that the number of veins may be highly variable and less than those reported in the English literature, but there is some similarity in the inguinal microanatomy of the right and left spermatic cords. Further research is warranted to clarify our results.     

Macroscopic and microsurgical varicocelectomy: what’s the intraoperative difference?

Purpose

Many authors reported that microsurgical varicocelectomy was among the best treatment modalities for varicocele. However, the difference in intraoperative anatomic detail between macroscopic and microsurgical varicocele repair in the same spermatic cord has not been critically discussed.

Methods

Between August 2010 and February 2011, 32 men with 42 sides’ grade 2–3 varicocele were enrolled in this study. One surgeon firstly mimicked the modified open varicocelectomy by identifying, isolating, and marking the presumed internal spermatic veins, lymphatics, and arteries. Another surgeon then checked the same spermatic cord using operating microscope to investigate the number of missed veins, to be ligated lymphatics and arteries in the “imitative” open varicocelectomy.

Results

There were significant differences in the average number of internal spermatic arteries (1.67 vs. 0.91), internal spermatic veins (6.45 vs. 4.31), and lymphatics (2.93 vs. 1.17) between microscopic and macroscopic procedure (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, an average of 2.14 ± 1.26 internal spermatic veins was missed; among them, 1.63 ± 1.32 internal spermatic veins adherent to the preserved testicular artery were overlooked. The number of 0.69 ± 0.84 lymphatics and 0.74 ± 0.74 arteries were to be ligated in “macroscopic varicocelectomy.” A number of 1.07 ± 1.11 lymphatics were neither identified nor ligated. In addition, in 2 cases, the vasal vessels of the vas deferens were to be ligated at macroscopic procedure.

Conclusions

Microsurgical varicocelectomy could preserve more internal spermatic arteries and lymphatic and ligate more veins which may interpret the superiority of microsurgical varicocele repair.     

Varicocele anatomy during subinguinal microsurgical varicocelectomy in Chinese men

Knowledge of subinguinal microsurgical varicocelectomy is of fundamental importance to ensure that varicocele is resolved and testicular function is preserved. Our study aimed to describe the number of veins, arteries and lymphatics in the subinguinal spermatic cord and to clarify their differences between two sides, between patients with different complaints and between varicoceles with different clinical grades. A total of 102 consecutive patients underwent 162 primary subinguinal microsurgical varicocelectomies, during which the number of vessels with different diameters was recorded. A mean number of 12.9 internal spermatic veins, 0.9 external spermatic veins, 1.8 internal spermatic arteries and 2.9 lymphatics were identified per cord. 88.2% of the internal spermatic arteries were surrounded by a dense complex of adherent veins. The external spermatic vein or veins were found in 49.4% of the cases. The mean number of medium (1–3 mm in diameter) internal spermatic veins on the left was larger than that on the right (P < 0.001). The mean number of medium internal spermatic veins in grade III varicocele was larger than that in grade I or grade II (P < 0.015). There was no significant anatomical difference between the men presenting for infertility, chronic testicular pain and both the two complaints.     

Loupe-assisted versus microscopic varicocelectomy： s there an intraoperative anatomic difference？

The aim of this study was to compare the intraoperative difference in anatomic details between Ioupe-assisted and microscopic varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men with 33 sides containing grade 2-3 varicocele were enrolled in this study. First, one surgeon performed the open inguinal varicocelectomy under x 3.5 Ioupe magnification. The presumed vascular channels and lymphatics were isolated and marked without ligation. Another surgeon then microsurgically dissected and checked the same spermatic cord using an operating microscope to judge the results in terms of the ligation of the internal spermatic veins and the preservation of the arteries and lymphatics. There were significant differences in the average number of internal spermatic arteries （1.51 vs 0.97）, internal spermatic veins （5.70 vs 4.39） and lymphatics （3.52 vs 1.61） between the microscope and Ioupe-assisted procedures （P 〈 0.001, P 〈 0.001, P 〈 0.001, respectively）. Meanwhile, in varicocele repair with Ioupe magnification, an average of 1.30 β± 1.07 （43/33） internal spermatic veins per side were missed, among the overlooked veins, 1.12 ± 0.93 （37/33） were adhered to the preserved testicular artery, as well as 0.55 ± 0.79 lymphatics and 0.36 ± 0.55 arteries that were to be ligated. In conclusion, microscopic varicocelectomy could preserve more internal spermatic arteries and lymphatics and could ligate more veins than the Ioupe-assisted procedure. To some degree, Ioupe magnification is inadequate for the reliable identification and dissection of the tiny vessels of the spermatic cord, as most of the overlooked veins were adhered to the preserved testicular artery.     

Modified high varicocelectomy: outpatient microsurgical procedure

Fifty patients underwent modified high varicocelectomy as outpatients. Twelve of the 22 unilateral varicocelectomies were performed under local anesthesia. All patients tolerated the procedures well, and none required admission to the hospital. The modified high approach, which exposes the area above the internal inguinal ring and of the posterior spermatic cord, is straightforward and insures that both internal spermatic and cremasteric veins can be ligated. Use of the operating microscope prevents the inadvertent ligation of the testicular artery and lymphatics.     

Intraoperative varicocele anatomy: a macroscopic and microscopic study.

Varicoceles are found in approximately 15% of all men in the general population and up to 41% of all infertile men. However, the exact location and relationship of internal and external spermatic arteries, veins and lymphatics within the inguinal portion of the spermatic cord have not been previously well described in infertile men. The results of detailed intraoperative macroscopic and microscopic surgical dissections of the spermatic cord and gubernaculum of 83 infertile men with 115 palpable varicoceles are described. Enlarged veins exiting the testis and traversing the gubernaculum were present in 48% of the dissections. Enlarged external spermatic veins were detected in 74% of all spermatic cords. Typically, small internal spermatic veins drained into a large vein more proximally in the spermatic cord. An average of 3.6 lymphatics per spermatic cord was identified and preserved during the dissections. A solitary testicular artery was observed in 69% of the dissections. The testicular artery was adherent to the posterior surface of a large internal spermatic vein in 50% of the dissections and was surrounded by a dense complex of closely adherent veins in 30%. To decrease the incidence of postoperative varicocele recurrences we suggest a surgical approach that addresses all identifiable dilated and connecting veins. These findings suggest that surgical approaches that include intraoperative access to and ligation of low inguinal (external spermatic) and gubernacular veins may cause fewer recurrences, unligated small internal spermatic veins may be a cause of varicocele recurrence, and large internal spermatic veins should be individually identified, dissected and ligated since the testicular artery and lymphatics are often adherent to these veins. Optical magnification is important to facilitate identification of lymphatics, testicular arteries and small internal spermatic veins.     

Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique.

Conventional techniques of varicocele repair are associated with substantial risks of hydrocele formation, ligation of the testicular artery, and varicocele recurrence. We describe a microsurgical technique of varicocelectomy that significantly lowers the incidence of these complications. The testicle is delivered through a 2 to 3 cm. inguinal incision, and all external spermatic and gubernacular veins are ligated. The testis is returned to the scrotum and the spermatic cord is dissected under the operating microscope. The testicular artery and lymphatics are identified and preserved. All internal spermatic veins are doubly ligated with small hemoclips or 4-zero silk and divided. The vas deferens and its vessels are preserved. Initially, we performed 33 conventional inguinal varicocelectomies in 24 men without delivery of the testis or use of a microscope. Postoperatively, 3 unilateral hydroceles (9%) and 3 unilateral recurrences (9%) were detected. For the next 12 cases 2.5x loupes were used resulting in no hydroceles but another recurrence (8%). We then performed 640 varicocelectomies in 429 men using the microsurgical technique with delivery of the testis. Among 382 men available for followup examination from 6 months to 7 years postoperatively no hydroceles and no cases of testicular atrophy were found. A total of 4 unilateral recurrent varicoceles (0.6%) was identified. The differences between the techniques in the incidence of hydrocele formation and varicocele recurrence are highly significant (p < 0.001). No wound infections occurred in any men. Four scrotal hematomas (0.6%), 1 of which required surgical drainage, occurred in the group with microsurgical ligation and delivery of the testis compared to none with the conventional technique. Preoperative and postoperative semen analyses (mean 3.57 analyses per patient) were obtained on 271 men. The changes in sperm count x 10(6) cc (36.9 to 46.8, p < 0.001), per cent motility (39.6 to 45.7%, p < 0.001) and per cent normal forms (48.4 to 52.10%, p < 0.001) were highly significant. The pregnancy rate was 152 of 357 couples (43%) followed for a minimum of 6 months postoperatively. Delivery of the testis through a small inguinal incision provides direct visual access to all possible avenues of testicular venous drainage. The operating microscope allows identification of the testicular artery, lymphatics and small venous channels. This minimally invasive, outpatient technique results in a significant decrease in the incidence of hydrocele formation, testicular artery injury and varicocele recurrence.     

Incidence and postoperative outcomes of accidental ligation of the testicular artery during microsurgical varicocelectomy

PURPOSE: In this study the frequency and outcomes of unintentional testicular artery ligation during microsurgical varicocelectomy were evaluated. MATERIALS AND METHODS: From 1984 to 2002, 2,102 cases of microsurgical varicocelectomy were evaluated. Accidental artery ligation was confirmed intraoperatively by observation of pulsatile twitching of the ligated vessel stump under 25x magnification. RESULTS: The complication was identified in 19 cases (0.9%) and all occurrences were unilateral, with 74% on the left side and 42% on the right side. In addition to the vasal artery at least 1 alternative artery was identified in all cases. Average testis volume before surgery was 15.8 ml. Azoospermia was found in 26% of cases. After surgery during the median followup of 19 months testicular atrophy developed in 1 patient (5%). In this cohort significant improvement was found in serum total testosterone in 80% (from 362 to 493 ng/dl) and in sperm count in 80% (from 12 to 22 x 10 per ml). Return of motile sperm to the ejaculate was found in 40% of azoospermic cases. The natural pregnancy rate was 14%, which is significantly lower than the 46% previously reported in the historical cohort of varicocelectomy cases. CONCLUSIONS: The incidence of accidental testicular artery ligation in microsurgical varicocelectomy was approximately 1%. Testicular atrophy developed in 1 patient (5%). Preservation of cremasteric and/or secondary internal spermatic arteries likely contributed to a low incidence of adverse outcomes. The natural pregnancy rate was low which may be due to the high proportion of azoospermic men before surgery. It is possible that the smaller testes usually associated with azoospermia indicate smaller testicular arteries, thus posing a greater risk of accidental ligation.     

经外环口以下途径显微镜下精索静脉结扎术治疗精索静脉曲张术后复发的疗效分析

目的分析精索静脉曲张(VC)术后复发的病因,探讨经外环口以下途径显微镜下精索静脉结扎术(MV)治疗复发VC的疗效。方法回顾性分析2015年4月至2019年4月青岛大学附属医院收治的16例VC术后复发患者的病例资料。中位年龄27(18~36)岁。5例既往曾行精索内静脉高位结扎术,11例曾行腹腔镜精索静脉结扎术;16例于术后1~3年复诊时诊断为VC复发。复诊病因包括婚后未育10例、阴囊疼痛12例,其中婚后未育合并阴囊疼痛者6例。本组16例复发后,术前评估VC临床分级Ⅲ级13例(左侧8例,双侧5例),Ⅱ级3例(均为左侧)。疼痛视觉模拟评分(VAS)中位值为2.5(0~4)分。彩色多普勒血流显像(CDFI)分度:Ⅲ度12例(左侧7例,双侧5例),Ⅱ度4例(均为左侧)。12例临床分级和CDFI分度均为Ⅲ级(度)者的左肾血管CDFI检查提示合并胡桃夹现象(NCP)。术前血清睾酮(16.2±4.9)nmol/ml,精子浓度(11.8±3.9)×10⁶/ml,前向运动精子比例(PR)(24.4±4.2)%。本组16例均行经外环口以下途径的MV手术。全麻,患者取平卧位。术中取腹股沟管外环口以下斜切口,分离显露精索,其下方插入纱布条并垫高。使用手术显微镜放大术野4~6倍,彻底结扎并切断扩张迂曲的精索外和精索内静脉所有分支,注意保护精索内动脉和淋巴管。术中11例仅行左侧MV手术,5例行双侧MV手术,所有患者术中均探及明显扩张迂曲的精索外及精索内静脉,通过MV手术可以清晰解剖并充分保护精索内动脉及淋巴管。术中每例平均结扎左侧精索外静脉(2.1±0.6)支、精索内静脉(10.1±1.1)支,解剖出左侧精索内动脉(1.3±0.5)支、淋巴管(3.0±1.0)支,结扎右侧精索外静脉(1.4±0.5)支、精索内静脉(6.6±0.5)支,解剖出右侧精索内动脉(1.4±0.5)支、淋巴管(2.6±0.5)支。记录患者术后6个月的VAS、阴囊触诊情况、CDFI、精液分析、血清睾酮等指标,并与术前比较。结果本组16例21侧MV手术均顺利完成。术后6个月复查,所有患者查体阴囊无明显迂曲血管团,Valsalva试验呈阴性。VAS中位值为0(0~2)分,较术前显著降低(Z=-2.994,P<0.05)。精子浓度(16.2±4.6)×10⁶/ml,PR(34.5±4.1)%,均较术前明显改善(P<0.05);血清睾酮水平(16.6±4.4)nmol/ml,较术前无显著变化(P>0.05)。复查CDFI提示精索内静脉无明显反流。16例术后随访期内均未发生睾丸萎缩、鞘膜积液等并发症。术后随访1~3年,10例因婚后未育就诊者中5例术后随访期内完成生育。结论VC术后复发与静脉漏扎有关,特别是对于Ⅲ级VC或合并NCP的VC患者,采用内环口以上的传统高位结扎术或腹腔镜手术极可能漏扎较细的精索内静脉和外环口以下水平的精索外静脉。经外环口以下途径的MV手术,通过彻底结扎精索内和精索外静脉,同时保护精索内动脉和淋巴管,不仅可有效避免VC术后复发及并发症,而且可以缓解阴囊坠痛症状和改善精液质量。