腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术的疗效比较

目的:对比观察腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术治疗精索静脉曲张的优点。方法:将36例腹腔镜下精索血管集束结扎术与38例腹腔镜下单纯精索内静脉结扎术的临床资料进行对比研究。结果:两组病例手术时间与术中出血量有明显差异(P<0.05);术后经12个月随访,两组间术后治愈率及复发率有明显差异(P<0.05)。结论:腹腔镜精索血管集束状结扎术与腹腔镜单纯精索内静脉结扎术相比,具有手术时间短、术中出血少、安全且治愈率高等优点。     

腹腔镜精索血管集束状结扎与改良Palomo术治疗精索静脉曲张的疗效比较

目的探讨原发性精索静脉曲张不育患者作腹腔镜精索血管集束状结扎术与改良Palo—mo术的治疗效果。方法选择原发性精索静脉曲张不育患者80例，均有不同程度的生精功能障碍。病例随机分为两组，第一组42例，行腹腔镜下精索血管集束结扎术；第二组38例，行开放式腹膜后精索静脉高位结扎术。两组术前及术后3个月检查精液分析。将42例与38例开放式腹膜后精索静脉高位结扎术的临床资料进行对比研究。结果两组病例手术时间与术中出血量有明显差异（P〈0．05）；术后经12个月随访，两组间术后复发率有明显差异（P〈0．05）。两组精液质量较术前均有改善，而两组间精液精子数量、活动力、畸形率比较无显著性差异（P〉0．05）。结论腹腔镜精索血管集束状结扎术与开放式腹膜后精索静脉高位结扎术均可提高精液质量，但前者具有手术时间短、术中出血少、安全且治愈率高的优点。     

精索静脉曲张患者术前、后精子顶体酶活性研究

目的 探讨精索静脉曲张患者在精索静脉高位结扎术前、后精子顶体酶活性(SAA)的变化。方法 用改良的Kennedy法测定术前和术后6～8个月精子顶体酶活性。结果 精索静脉高位结扎术后患者的精子顶体酶活性较术前明显增高(P<0.01)。结论 精索静脉高位结扎术后精索静脉曲张患者精液质量如精子顶体酶活性得到明显的提高。     

Role of spermatic vein phlebography and scleroembolization in treating varicocele and preventing its recurrence

The phlebograms and intravascular treatment of varicocele were performed in 406 patients aged from 10 to 60 years. Scleroembolization of the left internal spermatic vein was successfully used in 402 of them. Dilatation and retrograde flow through the right internal spermatic vein were recorded in 101 of 238 patients during transjugular catheterization. This investigation has confirmed high effectiveness of the method of the intravascular combined scleroembolization in treatment of varicocele. Using the transjugular access facilitates not only performing the left side intervention but represents the only efficient means to fulfill the right side phlebography of the spermatic vein and its obliteration. The strategy of using the bilateral intervention for the detection of retrograde contrast of the right internal spermatic vein considerably improves the results of treatment of varicocele and decreases risk of relapses.     

腹腔镜下精索内静脉高位结扎103例报告

目的:总结腹腔镜下精索内静脉高位结札的临床经验。方法:行腹腔镜下精索内静脉高位结扎术103例,其中左侧曲张80例,双侧曲张23例。结果:患者手术均获成功,无并发症发生,平均手术时间16～30min,术后平均住院4d。结论:腹腔镜下精索内静脉高位结扎术不仅是一种可选择的术式,而且视野清晰,操作简便、安全性高,患者痛苦小,损伤轻,恢复快,并发症少,是值得首选的术式。     

Varicocele treatment: prospective randomized trial of 3 methods.

This study was done to evaluate the surgical results and the impact on fertility potential of 3 methods of varicocele treatment. Consecutive varicocele patients with primary or secondary infertility were randomly assigned to 3 treatment groups. Of the patients 36 underwent percutaneous embolization, 55 high ligation of the internal spermatic vein and 28 transinguinal simultaneous ligation of the internal and external spermatic veins. The transinguinal ligation proved to be safe. There was no difference in pregnancy rates but the seminal variables showed a slight improvement with statistical significance only in the 2 open surgical methods. There were no surgical failures in the transinguinal group as opposed to the other 2 techniques. Transinguinal ligation of the internal and external spermatic veins may be recommended as the primary treatment for varicocele. This technique also seems to be the procedure of choice when repeat intervention is required for failure of high ligation or embolization.     

腹腔镜手术与开放手术治疗精索静脉曲张的对比性研究(附273例分析)

目的:对比研究腹腔镜和开放手术精索静脉高位结扎术治疗精索静脉曲张的疗效。方法:回顾分析121例腹腔镜和152例开放手术精索静脉高位结扎术的临床资料,比较两种方法在手术时间、术后住院天数及综合治疗费用及术后止痛药应用等的差异。结果:两组在手术时间、术后住院天数及止痛药应用等方面差异均有高度显著性(P<0.01),腹腔镜组均优于开放手术组;综合治疗费用两组差异无显著性(P>0.05)。结论:腹腔镜治疗精索静脉曲张较开放手术具有创伤小、康复快,术后住院时间短及美容效果好等优点。     

Postoperative hydrocele testis as a complication of high ligation of internal spermatic vein

We reviewed 785 patients with varicocele testis who underwent high ligation of internal spermatic vein at Kasukabe City Hospital between 1969 and 1985, and found only 3 patients suffering from postoperative hydrocele testis. Analysis of the hydrocele content in one case revealed a high protein level, which suggested that the etiology of the hydrocele after high ligation is of lymphatic origin, so that it is important to preserve the lymphatics of spermatic cord in order to prevent postoperative hydrocele.     

反麦氏切口腹膜后左精索内静脉高位结扎术(附250例报告)

目的：提高精索内静脉高位结扎术的治疗效果,减少手术并发症。方法：反麦氏（ＭｃＢｕｒｎｅｙ）切口经腹膜后进行左精索内静脉高位结扎术。结果：治疗左侧精索静脉曲张２５０例,术后１年未见精索静脉曲张复发,精子密度以及精子活动率较术前明显改善（Ｐ＜０．０５,Ｐ＜０．００５）。结论：该方法简便、创伤小、并发症少,是治疗精索静脉曲张不育症的有效方法。     

Doppler超声对精索静脉曲张不育患者生育力的估价

目的　研究Doppler超声对精索静脉曲张不育男性的诊断价值。 方法　本研究采用Doppler超声 ,对 82例精索静脉曲张所致不育患者的精索静脉的管径和血液返流进行了测定 ,同时结合这些患者的阴囊温度、睾丸体积、精液质量进行分析。 82例患者中随机选择了 4 1例进行精索内静脉高位结扎术。结果　 (1)精索静脉的管径与生育力指数呈负相关 ,而与血液返流的Doppler分级呈正相关。 (2 )在手术病人中 ,术前Doppler检测发现精索静脉内有血液返流者其术后效果较无返流者为好。结论　结果提示精索静脉的管径可能反映了精索静脉中血液返流的时间和严重程度 ,并且结合精液分析可估价精索静脉曲张患者生育力损害的程度     

Comparison of antioxidant enzyme activity in the internal spermatic vein and brachial veins of patients with infertile varicocele

AIM: Recent studies have shown that both oxidative and reductive stresses are present within the internal spermatic vein of patients with varicocele. The aim of this study was to compare the activities of antioxidant enzymes in the internal spermatic vein and brachial vein of patients with varicocele. METHODS: Fifteen primary infertile varicocele patients and ten normal-nonvaricocele-fertile control subjects participated in this study. The patients and subjects were first given a physical and color doppler examination, and then whole blood samples were drawn from the brachial vein and a dilated internal spermatic vein during surgery. Superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) enzyme activities were assessed by enzymatic methods, and the results were compared using the Mann-Whitney U test. RESULTS: The activity of SOD in the internal spermatic veins and brachial veins of patients with varicocele was 60.17 +/- 2.15 and 42.10 +/- 1.60 U/g protein, respectively; that of GSH-Px was 5.44 +/- 0.14 and 3.92 +/- 0.14 U/g protein, respectively. The results were statistically significant (P < 0.05). In the control group, the activity of SOD in the internal spermatic veins and brachial veins was 43.12 +/- 1.80 and 40.01 +/- 2.10 U/g protein, respectively; that of GSH-Px was 3.35 +/- 0.20 and 3.7 +/- 0.10 U/g protein, respectively (P > 0.05). CONCLUSIONS: Increased antioxidant enzyme activity in the internal spermatic vein may be due to increased oxidative stress in the internal spermatic vein: the increase in antioxidant enzyme activity may be a response to offset the toxic actions of reactive oxygen species. Further studies are needed to confirm this suggestion.     

经脐单孔三通道腹腔镜下精索静脉曲张高位结扎15例临床分析

目的:总结经脐单孔三通道腹腔镜下精索内静脉高位结扎的临床经验。方法:经脐单孔三通道腹腔镜下精索内静脉高位结扎术15例,其中左侧曲张13例,右侧曲张2例。结果:患者手术均获成功,无近期并发症发生,平均手术时间28min,术后平均住院4d。结论:经脐单孔三通道腹腔镜下精索内静脉高位结扎术是一种治疗精索静脉曲张可选的新术式,患者痛苦小,恢复快,更具有良好的美容和微创治疗效果,操作难度不大。     

Orchiopexy using microvascular surgical technique

Orchiopexy of high intra-abdominal testes with division of the internal spermatic artery and vein is associated with subsequent testicular atrophy in a significant percentage of cases. We herein describe 2 patients in whom arterial supply and venous drainage to the testis were maintained using microvascular anastomosis. The internal spermatic artery and vein were anastomosed to the deep inferior epigastric artery and vein. Patency of the vascular anastomosis was verified by subsequent radionuclide examinations and selective arteriography in 1 patient.     

一孔法微型腹腔镜精索静脉高位结扎术

目的介绍一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张的手术方法,探讨其临床应用价值。方法采用一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张11例,年龄19～45岁,平均26岁,病程1个月至5年,单侧病变9例,双侧病变2例。结果单侧精索静脉曲张手术时间为10～20min,平均12min,双侧病变患者手术时间为1例20min,1例30min,平均25min。患者术后疼痛轻微、均无需使用止痛药,平均住院时间2．7d,随访1-3个月未见复发、阴囊气肿、阴囊水肿、鞘膜积液、睾丸萎缩等并发症。结论一孔法微型腹腔镜精索高位结扎术治疗精索静脉曲张疗效可靠,具有微创、安全、美观的优点。     

微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用：附视频

目的 探讨微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用价值.方法 回顾分析2012年1月至2013年1月期间中山大学附属第一医院东院收治的89例精索静脉曲张患者的临床资料.患者均行改良的腹股沟下显微精索静脉结扎术,2012年9月之前术中未应用微型血管多普勒,2012年9月之后术中常规应用微型血管多普勒辨别动脉和静脉.比较两组患者的临床资料.结果 89例患者共138次手术均获成功,术后随访3～6个月,未见睾丸萎缩和鞘膜积液发生.非多普勒组术中有1例精索内动脉被误扎,2例术中精索动静脉辨认不清,术后1例复发;多普勒组术中辨别动脉和静脉准确,无动脉损伤和误扎情况发生,术后无复发.结论 在微型血管多普勒辅助下行显微精索静脉结扎术更安全有效.     

Collateral circulation after spermatic vessel ligation for abdominal testis and its impact on staged laparoscopically assisted orchiopexy

PURPOSE: Staged laparoscopically assisted orchiopexy for abdominal testis entails initial spermatic vessels ligation followed by mobilization of the testis, preserving the vas and its vessels as a sole source of testicular blood supply. This mobilization includes all peritoneal attachments of the testis, including the gubernaculum, which may carry collateral circulation to the testis. This study considers the anatomy of the gubernaculum and the collateral circulation after spermatic vessels ligation and its possible effects on the viability of the testis. MATERIALS AND METHODS: The anatomy of the gubernaculum and the effect of spermatic vessels ligation on the collateral circulation were studied in 90 boys with 100 abdominal testes with a short pedicle. Patients with vanishing testis or those not needing ligation of the spermatic vessels were excluded from the study. The anatomy and the vascularity of the testis, gubernaculum, and vas were studied at initial laparoscopy and 6 weeks later after spermatic vessel ligation. Based on these findings, the technique for laparoscopically assisted orchiopexy were modified, preserving the gubernaculum whenever possible in cases having prominent collaterals. RESULTS: Based on the attachment and blood vessel configuration of the gubernaculum, the patients were divided into two groups: in group 1 (open internal ring), there were 46 testes in which the gubernaculum passed through an open internal ring having an inguinal attachment. In group 2 (closed internal ring), there were 54 testes with a soft gubernaculum attached to a closed internal ring without inguinal attachment. In group 1 the gubernaculum was short and tough in 32 of 46 testes, with no visible blood vessels in all cases. In group 2 the gubernaculum was long and soft in 43 of 54 testes and showing evident blood supply before clipping of the spermatic vessels in 30 testes. Subsequent laparoscopy done after 6 weeks showed prominent collateral circulation around the gubernaculum in 26 testes and around the vas in 20 testes in the group 1 patients, and around the vas in 20 and the gubernaculum in 34 testes in group 2. Preservation of the gubernaculum was possible in 43/54 (80%) of group 2 patients and in 14/46 (30%) of group 1 patients. CONCLUSION: Routine cutting of the gubernaculum is not necessary for proper mobilization of the abdominal testis: collateral circulation varies from patient to patient, and once the gubernaculum shows prominent blood supply, its preservation is mandatory. The decision to cut the gubernaculum should be taken while the performing initial spermatic vessel ligation and not during the second stage to avoid compromise of the settled collateral circulation.     

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...     

LAPAROSCOPIC VARICOCELECTOMY: INVASIVENESS AND EFFECTIVENESS COMPARED WITH CONVENTIONAL OPEN RETROPERITONEAL HIGH LIGATION

The invasiveness of laparoscopic varicocelectomy and- open retroperitoneal high ligation of the internal spermatic veins were compared and the surgical effects on fertility of these two procedures determined. 48 of 97 men diagnosed with varicocele testis underwent laparoscopic varicocelectomy, while the remaining 49 underwent open retroperitoneal high ligation of the internal spermatic vessels. Operating time, number of post-operative days to walking, length of hospital stay and analgesic use were measured as peri-operative indicators of invasiveness. In addition, seminal parameters were determined in order to evaluate the effects of these procedures on fertility. The operating time required for laparoscopic surgery was significantly longer than that for open surgery (96.6 vs 78.1 min., p = 0.0078). The patients in the laparoscopic surgery group began walking earlier post-operatively than did those who underwent open high ligation (0.97 vs 1.42 days, p = 0.00037). Length of hospital stay for the laparoscopic patients was shorter than for the open surgery group (7.05 vs 9.55 days, p=0.00001). There were no statistical differences between the groups in terms of semen quality or improvement in the post-operative rate of pregnancy of partners. These findings indicate that laparoscopic varicocelectomy is associated with a shorter period of convalescence than open high ligation of the internal spermatic vessels.     

Radiological anatomy of the internal spermatic vein(s) in 200 retrograde venograms.

The radiological anatomy of the internal spermatic vein(s) was studied in 200 retrograde venograms performed as part of presurgical evaluation in patients with variocele. A large range of anatomical variations was found at the left side. Bilateral reflux occurs in one out of four patients with unilateral varicocele at palpation. Bilateral treatment is therefore necessary in as much as one fourth of cases with 'unilateral' left side varicocele. In right side varicocele the spermatic vein generally enters the right renal vein. Varicocele ligation should be performed near the internal inguinal ring in order to interrupt reflux most securely. Non-surgical treatment of varicocele by means of sclerosis or embolization of the internal spermatic vein, will remain restricted to those cases in which reflux passes through only one spermatic vein. Insufficient knowledge of the anatomy of the internal spermatic vein(s), and the resulting incomplete interruption of reflux in this (or these) vessel(s) may be the cause of poor treatment results reported by some authors.     

Operative management of varicocele by high retroperitoneal ligation of the spermatic vein

High retroperitoneal ligation of the internal spermatic vein has been performed in 30 cases of varicocele. Renospermatic reflux had been demonstrated by preoperative phlebography in every case. Retrograde pressure brought to bear on the spermatic vein from the renal vein has been ascertained by intraoperative measurements of the pressures in the internal spermatic vein. On the ground of the results, high ligation of the spermatic vein is regarded as suitable for the surgical management of varicocele in case of renospermatic reflux.