左肾静脉压迫对左侧精索静脉曲张高位结扎术后复发的影响

目的分析左肾静脉压迫对左侧精索静脉曲张高位结扎术后复发的影响。方法回顾分析荆门市第一人民医院2009年8月至2011年4月收治精索静脉曲张患者117例,针对其术后复发情况行统计分析。结果单纯精索静脉曲张患者组行高位结扎术后复发率为1.28%（1/78）,合并左肾静脉压迫的左侧精索静脉曲张患者组行高位结扎术后复发率为10.26%（4/39）。结论合并左肾静脉压迫的左侧精索静脉曲张高位结扎术后患者复发率要高于单纯性精索静脉曲张患者。     

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。     

显微精索静脉结扎术治疗复发性精索静脉曲张(附37例报告)

目的:探讨复发性精索静脉曲张(VC)经腹股沟下显微精索静脉结扎术治疗的疗效。方法:回顾性分析2012年1月~2016年12月我院收治的37例复发性VC患者的临床资料及术后3、6、12个月的回访资料,分析术后疗效。结果:复发性VC患者平均手术时间为82.6min,手术结扎左侧精索内静脉条数平均12.8条,术后疼痛缓解率为89.7%。不育患者配偶自然妊娠率为40.0%。所有患者随访均无睾丸萎缩和鞘膜积液发生。结论:腹股沟下显微精索静脉结扎术治疗复发性VC安全、有效,长期效果仍需进一步大样本、多中心前瞻性研究。     

完全腹膜外路径在腹腔镜精索静脉高位结扎术中的应用

目的探讨完全经腹膜外路径腹腔镜下精索静脉高位结扎术的可行性。方法 2010年4月至2016年9月,硬膜外麻醉或全麻下采用手指钝性分离建立空间,使用传统腹腔镜器械行完全经腹膜外腹腔镜技术治疗精索静脉曲张(VC)78例。结果 78例手术均获成功,无中转开放手术,手术时间(60.1±30.5)min,术中出血量(10.2±6.2)m L,术后住院时间(3.5±1.2)d,术中、术后基本无并发症,腹壁无明显手术瘢痕。结论完全经腹膜外腹腔镜下精索静脉高位结扎术是安全、有效的手术方法,操作空间较常规腹腔镜精索静脉高位结扎术更小,难度更大,但其较常规腹腔镜精索静脉高位结扎术更加微创,不干扰腹腔,无腹腔内并发症,为微创外科时代腹腔镜下治疗VC提供了新的手术路径。     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张85例报告

目的:探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的有效性、安全性及价值。方法:回顾分析我院为85例患者行腹腔镜精索静脉高位结扎术的临床资料。结果:85例手术均获成功,平均手术时间32min,基本无出血,术后平均住院3d。随访3～10个月,3例复发,复发率3.5%。结论:腹腔镜下精索静脉高位结扎术治疗精索静脉曲张具有创伤小、康复快、效果好、并发症少等优点,对双侧精索静脉曲张及开放手术后复发的患者尤有临床价值。     

丹红通精方对双侧精索静脉曲张术后精子质量的疗效观察

目的:探讨不同程度的精索静脉曲张(VC)对精子质量的影响及丹红通精方对双侧VC患者术后精子质量的影响.方法:将68例双侧VC患者随机分为对照组和治疗组各34例.对照组采用显微镜下精索静脉结扎术,治疗组在显微镜下行精索静脉结扎术后予"丹红通精方"中药颗粒口服,治疗前和治疗后检查精液多参数分析、正常形态精子率、精子顶体酶定...     

CEUS诊断精索静脉曲张侧支反流

目的 探讨CEUS诊断精索静脉曲张(VC)侧支反流的临床意义.方法 对60例单纯左侧VC患者行精索静脉CEUS,观察是否存在开放侧支血管,并用Doppler检测反流情况.根据造影结果将60例VC患者分为无侧支组(A组)和有侧支组(B组).造影完成后对全部患者行精索内静脉高位结扎术,并于术前及术后6个月检查精液质量、睾丸大小、术后复发及配偶受孕情况,以评价治疗效果.结果 A组41例(41/60,68.33％),B组19例(19/60,31.67％).B组27支侧支血管开放,其中13例18支侧支血管检测出反流频谱.术后6个月复查,两组患者的左侧睾丸体积较术前均有所增大(P＞0.05);与术前比较,术后A组精液质量较B组有明显改善(P＜0.05);术后A组无复发病例,B组5例复发;A组7例、B组2例的配偶受孕成功.结论 精索内静脉高位结扎术对无开放侧支血管VC的治疗效果好于有开放侧支血管者.侧支反流是术后VC复发的主要原因.CEUS可于术前诊断阴囊段及腹股沟段VC合并侧支反流,为外科选择治疗方案提供依据.     

慢性前列腺炎合并精索静脉曲张526例总结

目的 总结慢性前列腺炎(CP)合并精索精脉曲张(VC)诊断和治疗经验.方法 526例CP合并VC行超选择性精索内静脉高位结扎术.术后根据CP分型、慢性前列腺炎症状指数(CPSI)评分进行4～8周个体化治疗.结果 术后3个月彩色多普勒血流显像仪(CDFI)测量精索静脉内径小于1.8mm468例,1.8mm以上58例.术后2个月526例患者的CPSI由治疗前19.2 ±4.8减少到治疗后的4.8±3.4,CPSI分值减少15.8;前列腺液常规正常388例(73.3%),细菌培养转阴146例(79.7%),手术前后对比,差异有显著性意义(p＜0.01).结论 CP合并VC的患者在精索内静脉结扎术后明显提高了CP的疗效.     

日间手术在局麻下显微精索静脉结扎术中的应用

目的:探讨局麻下显微精索内静脉结扎术用于日间手术模式的安全性和有效性.方法:回顾性分析长江大学附属第一医院泌尿男科2018年4月-2019年12月收治的100例原发性精索静脉曲张(VC)患者资料,按照住院模式不同分为日间手术组(研究组)50例和常规手术组(对照组)50例.研究组患者日间手术模式下行显微精索静脉结扎术,对...     

显微镜与腹腔镜下精索静脉结扎术治疗精索静脉曲张的疗效比较

目的 比较显微镜下精索静脉低位结扎术和腹腔镜下精索静脉高位结扎术治疗精索静脉曲张(VC)的疗效.方法 前瞻性分析Ⅱ度以上原发性VC患者140例,随机分2组进行治疗.A组:显微镜下精索静脉低位结扎术组70例;B组:腹腔镜下精索静脉高位结扎术组70例.术前两组在年龄、婚姻、患病的单双侧等方面的差异经检验无统计学意义.比较两种治疗方法的手术时间、术后住院时间及住院费用;对比两组术后阴囊水肿,睾丸萎缩,复发等近、远期并发症及精液改善和生育情况.结果 140例患者中,平均住院时间A组(2.7±0.5)d,B组(3.1±0.7)d;平均手术时间A组(31.0±10.1)min,B组(29.3+8.2)min,这两项两组比较差异均无统计学意义.中位住院费用A组2 956元,B组5 847元,两组比较差异有统计学意义(P＜0.05).术后7d阴囊水肿A、B组发生率分别为1.4%(1/70)、7.1%(5170),两组比较差异有统计学意义(P＜0.05).A、B组术后6个月复发率分别为2.8%(2/70)、4.2%(3/70);术后3个月睾丸萎缩发生率分别为1.4%(1/70)、2.8%(2/70);两组比较差异无统计学意义(P＞0.05).A组术后6个月精液质量提高率高于B组(P＜0.05).A、B组术后2年内配偶自然受孕率分别为55.7%(39/70)和52.8%(37/70),组间比较差异均无统计学意义(P＞0.05).结论 显微镜下精索静脉低位结扎术和腹腔镜下精索静脉高位结扎术治疗VC都是简单、有效的治疗方式,但前者更经济,便于基层推广.     

Anatomy of the spermatic venous plexus (pampiniform plexus) in men with and without varicocele: intraoperative venographic study.

Venous anatomy of the testis was reexamined by retrograde spermatic venography during surgery in 17 men with and in 11 without a varicocele. The route of venous drainage of the testis was the internal spermatic vein and the external pudendal vein. The cremasteric and vasal veins were smaller collaterals. There was no cross communication between the right and left spermatic venous systems in the scrotal, retropubic or pelvic areas. In men with a varicocele the spermatic venous plexus was formed of numerous venous sinuses and large dilated veins.     

A case of non-traumatic rupture of varicocele

We report a case of a non-traumatic rupture of varicocele. A 28-year-old man visited our hospital complaining of left scrotal swelling with severe spontaneous pain of sudden onset after straining for defecation. MRI revealed a dilated spermatic cord with scrotal hematoma surrounding the left testis, which leads to the diagnosis of varicocele rupture. Conservative treatment with oral analgesics for a couple of weeks relieved the swelling and pain. Subinguinal microscopic ligation of left spermatic veins was performed 4 months later.     

放射性核素阴囊闪烁显像术诊断精索静脉曲张的效果观察

目的　探讨放射性核素阴囊闪烁显像术对诊断精索静脉曲张的价值。方法　本文收集 30例临床检查和 (或 )精液化验定型为精索静脉曲张的病人 ,分别行阴囊闪烁显像术检查计算机定量分析描计时间放射性曲线 ,计算两侧阴囊区每像素平均计数值、阴囊血池指数值 ,并观测阴囊部位是否有血液返流 ,对精索静脉曲张进行分型、定度 ,并与临床检查和彩色多普勒血流显像结果对比。结果　三种检查方法对临床型精索静脉曲张的分度差别无显著意义 ;阴囊闪烁显像术与彩色多普勒显像对亚临床精索静脉曲张的分度差别无显著意义。结论　该方法是诊断临床型精索静脉曲张、亚临床精索静脉曲张的简单、安全、有效的无创诊断方法。     

Low inguinal approach for correction of recurrent varicocele

The purpose of this study was to evaluate the efficacy of low inguinal (or subinguinal) approach in the treatment of recurrent of persistent varicocele after surgical treatment. Recurrent varicocele was diagnosed in 23 patients who previously underwent surgical treatment. The technique used consisted of low inguinal incision at the level of the external inguinal ring without opening the external oblique aponeurosis. External spermatic veins (cremasteric veins) were dissected and selectively ligated. Then the spermatic fascia was incised and the internal spermatic veins were identified and ligated individually. Postoperative radioisotope scan, scrotal examination and sperm analysis were used for treatment evaluation. Twenty-one (91.3%) had negative postoperative scan and no signs of varicocele on physical examination. A marked improvement of sperm analysis was noted in 19 patients (p<0.05), while two had only minor improvement. Two patients had positive postoperative scans without improvement of semen analysis. Neither atrophy nor azoospermia were detected on follow-up examination in any of these men, however, one patient developed hydrocele. This study indicates a good surgical outcome and improvement of semen quality without significant complications.     

不同手术方式治疗精索静脉曲张的疗效比较

目的 比较高选择性精索静脉高位结扎术、经腹股沟管入路精索静脉结扎术和腹腔镜下改良Palomo术3种方法治疗精索静脉曲张的效果. 方法回顾性分析Ⅱ度以上原发性精索静脉曲张患者1075例,685例获随访.根据手术方式分3组:A组为高选择性精索静脉高位结扎术组,369例;B组为经腹股沟管人路精索静脉结扎术组.218例;C组为腹腔镜下改良Palomo术组,98例.对比观察3组术后阴囊水肿,睾丸、局部皮肤疼痛、麻木,睾丸萎缩,复发等远、近期并发症及精液改善和生育情况. 结果 A、B、C 3组复发率分别为3.3%(12/369)、7.3%(16/218)、5.1%(5/98),A、B组间比较差异有统计学意义(P<0.05);术后3个月睾丸萎缩发生率分别为0.5%(2/369)、17.9%(39/218)、9.2%(9/98),3组间比较差异有统计学意义(P<0.05);术后阴囊水肿发生率分别为1.4%(5/369)、17.4%(38/218)、16.3%(16/98),A组与B、C组间比较差异有统计学意义(P<0.05).A组≤30岁患者术后3～6个月精液质量提高率和术后1～2年配偶自然怀孕率高于其他2组≤30岁患者(P30岁者(P<0.05). 结论 高选择性精索静脉高位结扎术简单且术后阴囊水肿和睾丸萎缩发生率低,术后精液质量提高率和术后1～2年内配偶自然怀孕率高,值得临床推广.     

精索静脉曲张与氧化应激的研究

目的 :研究精索静脉曲张 (VC)时氧化应激的损害机制。　方法 :2 8例VC不育男性 ,行精索内静脉结扎术 ,采精索内静脉血和外周静脉血 ;建立大鼠左侧VC模型 (n =12 ) ,以假手术大鼠为对照组 (n =8) ,术后 3个月取睾丸组织。采用分光光度法检测VC男性血浆及大鼠睾丸组织中一氧化氮 (NO)、一氧化氮合酶 (NOS)、黄嘌呤氧化酶(XO)、乳酸 (Lac)和乳酸脱氢酶 (LDH)含量。　结果 :VC患者精索内静脉血浆中NO、NOS、XO、Lac含量明显高于外周静脉血浆 (P <0 .0 1,P <0 .0 5 ) ,LDH明显降低 (P <0 .0 1)。实验性VC大鼠左侧睾丸组织NO、XO高于对照组 (P <0 .0 1) ,Lac明显降低 (P <0 .0 1)。　结论 :VC时 ,可由于曲张精索静脉血浆中NO、NOS和XO及睾丸组织中NO和XO产生增加 ,以及Lac和LDH含量的变化 ,而导致精子生成障碍或 /和精子活力下降 ,引起男性不育。     

Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach

PURPOSE: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique. MATERIALS AND METHODS: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery. RESULTS: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases. CONCLUSIONS: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.     

Pattern of varicocele vein blood gases in patients undergoing microsurgical Varicocelectomy

Background

Varicocele is known to be associated with infertility and sperm disorders. The exact cause of this ailment is not fully understood. There are limited numbers of studies where venous blood gases (VBGs) of varicocele veins were determined with conflicting results. Therefore, we have investigated the pattern of VBGs in both internal spermatic and external spermatic varicocele veins and correlation with semen quality parameters in infertile individuals who underwent left microsurgical varicocelectomy.

Methods

Patients (n?=?27) undergoing left microsurgical varicocelectomy at a tertiary care hospital, were included in the study. Before surgery, semen parameters and scrotal color Doppler ultrasonography was performed. During surgery, blood sample was drawn from varicocele veins (internal spermatic and external spermatic veins) and a peripheral arm vein of the same patient as a control. The VBGs of all veins under study were estimated and compared with each other. The VBGs were also correlated with various semen quality parameters. Data, expressed as Mean?±?SD, regarding VBGs in three veins were analyzed using one-way ANOVA. The correlation between VBGs and semen quality parameters was determined using Pearson’s correlation. Differences were considered significant at p?<?0.05.

Results

The pH was found to be higher (p?<?0.01) in the internal spermatic vein compared with the external spermatic and the peripheral veins. Partial pressure of oxygen (pO₂) and oxygen saturation (sO₂) were higher (p?<?0.01) in the internal spermatic vein compared with the peripheral vein. However, concentration of bicarbonate (HCO₃₎ was lower (p?<?0.01) in both veins compared with the peripheral vein. Partial pressure of carbon dioxide (pCO₂) was also lower (p?<?0.01) in the varicocele veins compared with the control vein.

Conclusion

The internal spermatic veins had higher pH and oxygen tension, but lower HCO₃ and pCO₂ levels compared with the control peripheral veins. External spermatic veins had lower pCO₂ and HCO₃ but other VBGs were similar to the peripheral veins. The shift of VBGs of internal spermatic vein toward arterial blood pattern may be a missing link to understand the pathophysiology of varicocele.