彩超诊断精索静脉曲张及其临床价值

精索静脉曲张 (ＶＣ)是临床常见病 ,也是男性不育症的病因之一。过去主要靠临床病史及触诊诊断 ,缺乏准确的客观指标 ,尤其对触诊阴性的亚临床精索静脉曲张 (ＳＶＣ)诊断较为困难。为此 ,我们对临床诊断或拟诊为精索静脉曲张的患者 31例 ,合计 6 2条精索静脉进行彩色多普勒血流     

显微血管转流术治疗精索静脉曲张合并少精子症

目的研究显微血管转流术在精索静脉曲张合并少精子症的治疗效果和应用价值。方法采用精索内静脉高位结扎加显微血管转流术治疗66例(71侧)，观察其症状、体征的改善和随访观察精子质量的改变，以及其配偶妊娠率。结果转流术71侧术后7d体征消失51侧，明显好转20侧；随访半年～1年，症状、体征消失69例(97％)，精子质量正常或明显好转52例(78％)。其中术后精子密度≥20×109/L，向前运动的精子比率≥50％，精子头部形态正常≥30％有37例(56.3％)；精子密度由术前(5～15)×109/L，术后提高到(10～19)×109/L，精子活动率和活动力均有提高11例(16.7％)；术前精子密度＜5×109/L、术后＞5×109/L4例(5％)。26例配偶已获妊娠，妊娠率39.4％。结论精索静脉高位结扎加显微血管转流术由于在阻断静脉血逆流的同时，即时建立新的静脉回流通路，更有效的改善睾丸供血，在消除局部症状和体征，改善精子质量，提高妊娠率以及防止复发等方面有良好的疗效。     

腹腔镜治疗精索静脉曲张两种术式的疗效比较

目的：观察比较两种腹腔镜手术方式治疗精索静脉曲张的临床疗效.方法：将2006年7月～2009年3月就诊的116例精索静脉曲张患者随机均分为两组：A组予以腹腔镜精索血管高位集束结扎术（Palomo术式）,B组予以腹腔镜单纯精索内静脉高位结扎术（Ivanissevich术式）.分析两组之间术后近、远期并发症、复发率及术后精液改善情况等指标,比较其临床疗效.结果：两种手术方式术后精液质量均较术前明显提高（P〈 0.05）,但组间比较差异无统计学意义（P〉0.05）;两组术后精索水肿、睾丸鞘膜积液等近期并发症差异无统计学意义（P〉0.05）;均未出现睾丸萎缩等远期并发症;但A组复发率低于B组,差异有统计学意义（P〈0.05）.结论：两种手术方式治疗精索静脉曲张均有明显临床疗效,但Palomo术式因其术后复发率更少,且具有操作简便、治愈率高等优点,可作为手术治疗精索静脉曲张的首选.     

经外环精索静脉结扎术与腹腔镜高位结扎治疗精索静脉曲张的评价

目的评价开放手术经外环小切口精索静脉结扎术与腹腔镜高位结扎术两种术式对治疗精索静脉曲张(varicocele,VC)的临床应用价值。方法70例病人中经外环结扎术38例,腹腔镜高位结扎术32例。结果两组在手术时间和住院时间上均无明显差异(P>0.05),住院费用有明显差异(P<0.05);术后6个月随访,经外环低位结扎者无1例复发,腹腔镜高位结扎者中5例复发,占15.63%,两组间差异有显著性(P<0.05);精子质量均有明显改善,两组间差异无显著性(P>0.05)。结论经外环小切口精索静脉低位结扎比腹腔镜精索静脉高位结扎有明显的优点,是一种治疗单侧VC的经济、有效的方法。     

保留与不保留精索内动脉对治疗精索静脉曲张的疗效比较

目的观察腹腔镜手术保留与不保留精索内动脉对治疗精索静脉曲张的临床疗效,比较两种术式的优劣。方法将2011年7月至2012年8月在我院住院治疗的68例精索静脉曲张患者随机分为A、B两组,两组患者均实施经腹腔镜双侧精索静脉高位结扎术,A组术中保留精索内动脉,B组术中对双侧精索内静脉连同动脉集束结扎。分析比较两组的手术时间、并发症、疗效等。结果 68例患者均顺利完成,术后1个月复查症状均消失,曲张的静脉均明显缩小或消失。随访1年两组均无复发,均未发现睾丸萎缩,A组出现睾丸鞘膜积液2例,B组1例。A组手术时间明显长于B组(P0.05),在精液质量改善方面A组优于B组,在术后住院时间、术后并发症方面,两组差异无显著性(P0.05)。结论腹腔镜下精索内静脉高位结扎术保留精索内动脉比不保留精索内动脉有优势,在技术允许的情况下应尽量保留精索内动脉。     

腹壁下静脉转流术治疗精索静脉曲张术后复发20例体会

传统的精索静脉曲张,常采用腹膜后精索内静脉结扎术。但其缺点为复发率高,有文献报道高达15％。我院1988-05/1999-05,为120例精索静脉曲张患者行腹膜后精索内静脉结扎术,结果术后复发20例,复发率为15.2％。对此20例复发病例我们采用腹壁下静脉转流术再次为其手术,取得满意疗效,现报告如下     

应用显微外科治疗精索静脉曲张的体会

应用显微外科技术施行精索内静脉-腹壁下静脉转流手术治疗精索静脉曲张20例,结果症状在1~3个月内消失;8例不育患者中5例已致孕,致孕率达63%。认为显微外科技术的应用是保证转流手术成功的关键,可减少或避免出现并发症。     

显微技术精索静脉曲张大隐静脉转流术143例

目的 报道显微外科技术在精索静脉曲张合并不育症的治疗效果.方法 精索静脉曲张行大隐静脉转流术治疗143例,观察术后症状、体征的改善和精子的变化.结果 转流术后随访6～18个月.症状完全消失138例(98.57%),精子正常或好转79例(55.4%),精子活动率和活动力均有提高51例(35.7%),6～18个月妊娠49例,妊娠率达35%.结论 精索静脉曲张大隐静脉转流术在建立新的静脉回流通路,有效改善睾丸供血,消除症状,改善精子数量及质量,提高受孕率取得了良好的疗效.     

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。     

Glutathione‐S‐transferase‐oxidative stress relationship in the internal spermatic vein blood of infertile men with varicocele

This study aimed to assess glutathione‐S–transferase (GST) enzyme‐ oxidative stress (OS) relationship in the internal spermatic vein (ISV) of infertile men associated with varicocele (Vx). Ninety five infertile oligoasthenoteratozoospemic (OAT) men associated with Vx were subjected to history taking, clinical examination and semen analysis. During inguinal varicocelectomy, GST, malondialdehyde (MDA) and glutathione peroxidase (GPx) were estimated in the blood samples drawn from ISV and median cubital veins. The mean levels of GST, GPx were significantly decreased and the mean level of GPx was significantly increased in the ISV compared with the peripheral blood. The mean level of GST and GPx in the ISV was significantly decreased, and the mean level of MDA was significantly increased in Vx grade III compared with Vx grade II cases. There was nonsignificant difference in the mean level of GST in the ISV in unilateral Vx cases compared with bilateral Vx cases. There was significant positive correlation of GST with sperm count, sperm motility, GPx and significant negative correlation with sperm abnormal forms, MDA. It is concluded that ISV of infertile men associated with Vx has decreased levels of GST compared with peripheral venous circulation that is correlated with both OS and Vx grade.     

经腹膜后精索内静脉高位结扎治疗精索静脉曲张

目的：探讨经腹膜后小切口精索内静脉高位结扎治疗精索静脉曲张的手术效果。方法：采用麦氏点斜切口经腹膜后途径精索内静脉高位结扎治疗72例(94侧)精索静脉曲张患者。应用罂粟碱试验和阴囊内驱血以辨认精索内动、静脉,结扎静脉,保留动脉。结果：平均手术时间27min。术后3个月随访,2侧(例)复发,占2．1％(2／94)。治愈患者症状减轻或消失。结论：小切口高位腹膜后精索内静脉结扎术是一种创伤小、操作简便、疗效高的手术方法。     

精索静脉曲张不育患者精囊内静脉血中活性氧和抗氧化剂的关系(英文)

目的:以外周静脉血作为比较对象,评估精囊内静脉血中活性氧(ROS)和抗氧化剂的关系。方法:观察对象为68名患有精索静脉曲张的少弱精患者。在腹股沟的曲张精索静脉切除术中,提取精囊内血液样本和中央尺骨静脉血样本。分别测定这些血液样本中的三种 ROS(丙二醛[MDA]、双氧水[H_2O_2]、一氧化氮[NO])和四种抗氧化剂(过氧化岐化酶[SOD]、过氧化氢酶[Cat]、谷胱甘肽过氧化酶[GPx]、维生素 C)。结果:精囊内静脉血样内的 ROS 因素的平均值明显高于外周血中的值(MDA 18.7±1.4 nm/mL vs.15.4±1.4 nm/mL,H_2O_2 43.6±8.0 Um/mL vs.30.8±8.1 Um/mL,NO 2.3±0.5 nm/L vs.1.6±0.4nm/L,P<0.01)。而精囊内静脉血的抗氧化剂的平均值明显低于外周血中的值(SOD 1690.7±130.0 U/mL vs.1818.5±143.0 U/mL,Cat 38.9±6.1 mm/mL vs.47.9±10.2 mm/mL,GPx 20.4±8.1 U/mL vs.23.0±8.4 U/mL,维生素 C 0.3±0.1 vs.0.4±0.1 mg/dL,P<0.05)。结论:患有精索静脉曲张不育男性的精囊内静脉血相对于外周静脉循环,具有更高的 ROS 和更低的抗氧化剂。     

Evaluation of the role of varicocelectomy including external spermatic vein ligation in patients with scrotal pain

OBJECTIVES: The aim of the present study was to assess and compare pre- and postoperative scrotal pain in patients with varicocele who underwent varicocelectomy with different approaches. METHODS: The study included 144 consecutive patients with left-sided varicocele who had left scrotal pain for more than 3 months. All patients underwent varicocele ligation using either a subinguinal or inguinal approach with or without external spermatic vein ligation. We asked the patients to complete an 'Assessment Questionnaire for Scrotal Pain' both before and after the surgery. RESULTS: The surgery was successful in 101 (83.4%) of the 121 patients available for follow up. Seventy-four (61.1%) patients reported the complete resolution of pain while 27 patients (22.3%) reported partial resolution. Symptoms worsened in a single case and pain persisted postoperatively in 19 cases (15.7%). There were no statistically significant differences in the characteristics of the pain and grade of varicocele between postoperative groups. A significant difference was observed in postoperative success between patients who had external spermatic vein ligation and those who did not, regardless of the surgical approach (inguinal or subinguinal). All patients who reported complete or partial resolution of pain stated that they would recommend surgery to relatives with the same problem. CONCLUSIONS: Varicocelectomy using either inguinal or subinguinal approaches is an effective and reasonable treatment option in this patient group and should include external spermatic vein ligation for a satisfactory outcome.     

Comparative hemodynamic evaluations of varicocele by bidirectional ultrasonic Doppler sonography and phlebography of the internal spermatic vein

Clinical studies (degree of severity) and bidirectional ultrasonic Doppler sonography (Pressure-type, Shunt-type) of varicocele were compared with the phlebography of the internal spermatic vein (degree of spermatic incompetence, diameter of the int. spermatic v.). Doppler probe and phlebography are equivalent methods to demonstrate the venous reflux in palpable varicocele and for follow-up examination after sclerotherapy. The subclinical varicocele is discussed. The slight degree of spermatic incompetence (reflux by Valsalva's manoeuvre) is responsible for the small varicocele (grade I) and the Pressure-type. The severe degree of spermatic incompetence (spontaneous reflux) causes the Shunt-type and the large varicocele (grade III) as well as a dilatation of the internal spermatic vein.     

Comparison of spermatic vein histology in patients with and without varicocele

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.     

对比Palomo手术与腹膜后精索内静脉高位结扎术治疗精索静脉曲张

目的对比经腹膜后集束结扎精索血管（Palomo手术）与腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的疗效及并发症。方法对2000年7月-2006年6月间，25例采用Palomo术式，30例采用腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的临床资料进行对比分析。结果所有手术均获得成功，术后随访6月至2年。Palomo手术组手术时间12～18min，手术后3—10d曲张静脉团显著缩小，所有患者临床症状消失。随访18例，无复发，无睾丸坏死或萎缩发生，6个月内发生左侧睾丸鞘膜积液3例，占16．6％，左侧慢性附睾炎1例，左侧睾丸疼痛（排除其它原因）1例。单纯精索内静脉高位结扎组手术时间20-35min，1例术后无效，29例术后1—8d曲张静脉团消失。3例术后2—4月后复发，占15％。精索内静脉高位结扎组术后复发率显著高于Palomo手术组（P〈O．05），而后者术后并发症明显高于前者，两者有显著的统计学差异（P〈0．05），主要并发症是患侧的睾丸鞘膜积液。后者手术时间明显较短（P〈0．01）。两组手术均效果良好，疗效可靠。结论Palomo手术简单易行、疗效可靠，但并发症较多；腹膜后精索内静脉高位结扎复发率高，但无并发症发生。     

A new experimental inbred Wistar rat varicocele model: anatomy of the left spermatic vein and the effect on histology

Because of venous anatomical differences between rats and humans and the personal interpretation of these differences, there is neither consistent animal prototype nor consistent results in the study of varicocele. We established a new substrain of Wistar inbred rats, of which the left testis vein has no significant branches to the common iliac vein up pampiniform plexus, but instead enters the left renal vein directly (similar to humans) and used them to create experimental varicocele model by partial ligation of the left renal vein. One month later, the predominant lesion of the left testis in induced group was spermatogenic arrest at the spermatid and preliminary spermatocyte phases, and considerable interstitial and Sertoli cell vacuolation. The right testis also showed spermatogenic arrest. Most important, the characteristics of the lesions differed in both testes, with the left testis having more severe lesions. Allowing for the unique anatomy of the left spermatic vein, the standard of the surgical procedure, the high rate of varicocele induction, and identical histological alteration as occurs in humans, we believe that this inbred Wistar rat substrain is suitable for the creation of an experimental varicocele model, which has promise for practical application in humans.     

精索静脉高位结扎术对精子DNA碎片的影响

目的:探讨精索静脉高位结扎术对精子DNA碎片影响及手术效果的评价。方法:精索静脉曲张(Varicocele,VC)患者34例,均行精索静脉高位结扎术。术前和术后3个月按WHO推荐方法进行精子运动指标(10项)、精子巴氏染色形态分析和精子DNA碎片分析检测。结果:VC患者术后正常精子形态比例明显高于术前,有显著性差异(P<0.01),术后精子DNA碎片比率、精子畸形指数(Sperm deformity index,SDI)和多种异常指数(Multiple anomalies index,MAI)均明显低于术前,有显著性差异(P<0.01);术后精子浓度、b级精子率均较术前升高,有显著性差异(P<0.05);术后a级精子比率、(a+b)级精子比率均比术前明显升高,有显著性差异(P<0.01)。VCⅠ级、Ⅱ级、Ⅲ级组术后精子DNA碎片比率均较术前明显降低,差异有统计学意义(P<0.01);亚临床型VC组术后精子DNA碎片比率与术前无显著差异(P>0.05)。VC术后大晕环精子比率较术前明显增多,有显著性差异(P<0.01);术后中晕环、小晕环、无晕环精子比率均较术前降低,有显著性差异(P<0.01)。结论:行精索静脉高位结扎术能有效改善VC患者的精子质量。