精索静脉曲张高位结扎术的手术配合及护理体会

目的：探究精索静脉曲张高位结扎术的手术配合方法,并谈论相关的护理体会。方法对200例精索静脉曲张患者进行手术前心理辅导、有关精索静脉曲张高位结扎术的知识的教导、术中配合、术后观察切口及切口护理。结果200例患者经过结扎手术的治疗,在术后7~10d可以出院,以及未出现1例复发。结论高位结扎术治疗精索静脉曲张,加强围手术期的配合工作,并对患者给予相应的护理,可以有效地治疗精索静脉曲张、防止病情复发。     

开放和经腹腔镜Palomo术式治疗未成年人精索静脉曲张疗效的Meta分析

背景:近年来对临床上应用不同手术方式治疗精索静脉曲张的研究很多,开放、腔镜及显微外科等术式各有利弊,尤其是对未成年人精索静脉曲张治疗方式的选择尚存较大争议。目的:系统评价开放和经腹腔镜途径Palomo术式治疗未成年人精索静脉曲张相关文献的治疗效果。方法:检索Medline数据库、Cochrane图书馆和中国生物医学文献数据库(CBM)2000-01/2010-01发表的有关未成年精索静脉曲张患者接受各种Palomo术式治疗效果的临床随机对照研究文献。英文检索词为"Varicocele;Palomo",中文检索词为"精索静脉曲张;Palomo术"。对资料进行初筛,选取针对性强的文章,排除重复研究,同一领域的文献则选择近期发表或权威杂志的文章。对筛选出的文献查找全文。由两名评价者独立提取资料、选择实验,并评估相关方法学质量,对检索得到的文献数据用RevMan4.2软件进行Meta分析。结果与结论:共纳入7篇符合标准的文献,其中中文1篇,英文6篇,共计1206例患者。Meta分析结果显示:接受各种不同方式的开放手术组和经腹腔镜手术组在复发率[OR=1.22,95%CI(0.48,3.12),P=0.67]和鞘膜积液发生率[OR=0.76,95%CI(0.28,2.02),P=0.58]的比较均无显著性差异。改良Palomo手术组术后精索静脉曲张的复发率要高于传统Palomo手术组[OR=0.19,95%CI(0.05,0.65),P=0.008],而术后鞘膜积液的发生率要低于传统Palomo手术组[OR=8.36,95%CI(1.88,37.12),P=0.005]。结果表明,开放和经腹腔镜手术两种术式在主要指标差异的比较未见明显差异,传统和改良Palomo术式则各有优缺点。     

不同手术方式治疗单侧原发性精索静脉曲张的疗效

目的 比较采用显微镜下精索静脉结扎术、腹腔镜下精索静脉高位结扎术、精索静脉高位结扎术治疗单侧原发性精索静脉曲张的临床疗效,为其临床诊疗提供参考。方法 回顾性分析212例单侧原发性精索静脉曲张患者的临床资料,其中采用显微镜下精索静脉结扎术治疗者48例(显微镜组),采用腹腔镜下精索静脉高位结扎术治疗者74例(腹腔镜组),采用精索静脉高位结扎术治疗者90例(开放组)。比较患者手术时间、术中出血量、胃肠功能恢复时间、术后住院时间、手术前后精液质量参数及差值、复发率及术后并发症发生率。结果 显微镜组手术时间长于腹腔镜组和开放组,术后住院时间短于腹腔镜组和开放组,差异均有统计学意义(P 0. 05)。显微镜组术中出血量小于开放组,差异有统计学意义(P 0. 05)。术后6个月,3组患者精液质量参数(精液浓度、前向运动精子率、正常形态精子率)均较术前明显升高,差异有统计学意义(P 0. 05)。显微镜组手术前后精液浓度差和前向运动精子率差均高于腹腔镜组和开放组(P 0. 05)。3组胃肠功能恢复时间、手术前后正常形态精子率差、复发率及术后并发症总发生率比较,差异均无统计学意义(P 0. 05)。结论 显微镜下精索静脉结扎术能缩短术后住院时间,改善精液质量,是治疗单侧原发性精索静脉曲张较为理想的术式。     

睾丸静脉与腹壁下静脉吻合术治疗精索静脉曲张的解剖学研究和临床应用

对50侧成年男尸的睾丸静脉和腹壁下静脉作了解剖学观测,并采用显微外科技术对6例精索静脉曲张的病人施行睾丸静脉与腹壁下静脉吻合术。介绍手术方法,讨论精索静脉曲张与男性不育的关系,指出本术式较睾丸静脉高位结扎术更有利于解除睾丸瘀血和造精功能的恢复。     

精索静脉曲张患者手术前后精液质量及精子形态变化的研究

目的探讨精索静脉曲张患者手术治疗前后精液质量及精子形态的变化。方法选择我院泌尿外科精索静脉曲张患者70例,分别在手术前和手术后进行精液常规分析和精子形态学分析。结果 70例精索静脉曲张患者手术后精子密度、活率和A级精子活力百分率较术前明显提高,精子畸形率明显降低,两组差别有显著性意义（P〈0.05）。结论精索静脉曲张可对男性生殖功能产生不良影响。     

腹腔镜集束性精索内血管高位结扎术治疗双侧精索静脉曲张的疗效分析

目的 分析腹腔镜下集束性精索内血管高位结扎术治疗双侧精索静脉曲张的可行性及临床疗效。方法 回顾性分析本院2016年6月~2018年3月收治的双侧精索静脉曲张并实施腹腔镜下集束性精索内血管高位结扎术治疗患者78例,比较术前与术后6个月睾丸大小及精液质量;评估手术疗效、术后复发及术后并发症发生情况。结果 纳入的78例患者手术均成功,手术时间为（24.80±5.50）min,术中出血＜5 ml;平均住院时间（5.10±0.80）d;除3例失访,其余75例患者,术后6个月睾丸体积均较术前增大,术后精液质量较术前提高（P＜0.05）;患者均无睾丸萎缩发生,临床症状明显缓解,1例患者术后第5个月复发,为结扎丝线滑脱所致;4例患者发生附睾炎（5.33%）,经常规治疗均好转。结论 腹腔镜下集束性精索内血管高位结扎术治疗双侧精索静脉曲张安全可靠、疗效明显、并发症少、复发率低且对术后患者睾丸功能的恢复效果显著,可常规应用于临床。     

精索静脉腹壁下静脉转流治疗精索静脉曲张疗效的进一步观察

<正> 1978年以来,采用精索静脉—腹壁下静脉转流治疗精索静脉曲张62例。随访44例3～20个月,证实此术式设计合理,较精索静脉高位结扎有利于解除精索静脉曲张所致的睾丸淤血和睾丸功能改变,不增加病人创伤。血管应用显微外科技术吻合,以保证吻合     

改良Palomo手术治疗精索静脉曲张36例

原发性精索静脉曲张是泌尿科常见病,手术为有效治疗方式,但术后复发和术后睾丸坏死或萎缩等并发症时有发生,改进手术方法是避免上述并发症的可行方案.我院自1998年8月至2003年2月采用改良的Palomo手术治疗精索静脉曲张36例,近期效果满意.现报告如下.     

两种不同精索静脉结扎术疗效比较（附62例报告）

精索静脉曲张是男性不育症的原因之一，治疗的方法有：开放手术高位结扎精索静脉、逆行或顺行硬化治疗、小切口手术及腹腔镜下精索静脉高位结扎术。各种技术各有其优缺点，不同的方法得出的结果可能不同。2006年1月至2007年12月，我院分别采用腹腔镜下精索静脉高位结扎术、微创外科手术治疗精索静脉曲张22例和40例，对两组的治疗结果进行比较，现报道如下。     

颈肩技术在前入路腹股沟疝修补术中应用的解剖学探讨

目的 探讨颈肩技术在前入路腹股沟疝无张力修补术中的解剖要点和操作技巧。方法 回顾分析南京医科大学附属苏州市立医院普外科自2012年1月—2016年12月应用颈肩技术进行的腹股沟疝无张力修补术156例患者的临床资料,观察术中解剖特点、术后恢复情况及相关并发症,总结颈肩技术的解剖要点和操作技巧。结果 手术均顺利完成,手术时间平均(48±15)min;术中出血平均5 mL;术后1天下床活动。术后出现发热61例,予对症处理后好转;皮下或阴囊水肿19例,均自行吸收;慢性疼痛5例,经口服药物或局部封闭治疗后好转。术后随访6个月,无疝复发。结论 颈肩技术的解剖学要点在于“真疝囊颈”的辨别,通过提睾肌途径、精索途径及直疝途径等入路,快速建立起腹膜前间隙空间,能够使补片放置更可靠,减少副损伤,节省手术时间,值得推广。     

An Analysis of Major Causes of Surgical Failure Using Bähren System in Intraoperative Venography During Varicocelectomy

PurposeIn young patients with varicocele, preservation of the internal spermatic artery may be advantageous for catch-up growth, but it may also increase the likelihood of treatment failure. Intraoperative venography reduces the likelihood that unsealed veins will remain after varicocelectomy. We analyzed the characteristics of remnant veins visualized through intraoperative venography to investigate the cause of surgical failure in artery-sparing varicocelectomy (ASV).Materials and MethodsWe retrospectively analyzed clinical characteristics and outcomes of patients aged 18 years or younger who underwent varicocelectomy with intraoperative venography from January 2005 to December 2017. During varicocelectomy, intraoperative venography was performed to distinguish veins from other structures. Any unsealed veins that were discovered were ligated and classified using the Bahren system.ResultsOne hundred and sixty-two patients underwent intraoperative venography: 153 cases (94.4%) were for primary varicocelectomy, and 9 cases (5.6%) were for repeat varicocelectomy. Open varicocelectomy was performed in 105 cases (64.8%), and laparoscopic varicocelectomy was performed in 57 cases (35.2%). Venography revealed remnant veins after the first ligation in 51 cases (31.2%), 46 (90.2%) and 5 (9.8%) of which were Bähren types 3 and 4, respectively. Five patients (3.1%) experienced varicocele recurrence, classified as persistence in 1 patient (0.6%) and relapse in 4 patients (2.5%).ConclusionRemnant collateral veins of the internal spermatic vein (ISV) (Bahren type 3) are the most common cause of failure in ASV. In a few patients, an external spermatic vein merges with the ISV at a higher level (Bahren type 4) and is unidentifiable without venography.     

Cavernous hemangioma of spermatic cord: report of a case with immunohistochemical study

We present a case of spermatic cord cavernous hemangioma. A 32-year-old man presented with a circumscribed, painless mass in the left side of the spermatic cord. An orchiectomy of the left testicle was performed. A 3 x 3 x 2.5-cm mass was present in the spermatic cord area. Histologic examination and immunohistochemical study showed a benign vascular tumor composed of vascular spaces of varying size. Although cavernous hemangioma can occur in any location, the spermatic cord is an extremely rare site, and, to our knowledge, only a few cases have been previously reported.     

精索静脉曲张Marmar术式的解剖学基础研究

目的探讨精索静脉曲张Marmar术式的解剖学基础。方法选择雄性SD大鼠100只,随机分为手术组80只和对照组20只,手术组分离及缩窄左肾静脉,对照组只分离不缩窄左肾静脉,同一条件下饲养8周,分别解剖两组大鼠精索静脉,并做血管铸型,记录及比较精索静脉系统分支数目、直径、侧枝循环数目和曲张程度。结果手术组有51只sD大鼠可以观察到精索静脉明显曲张,腹股沟内环口水平以上及外环口水平以下精索静脉的直径较对照组明显增粗,差异均有统计学意义。手术组大鼠出现明显增粗的侧枝循环,出现的侧枝循环大部分位于外环口平面以下。对照组无或1～2支极细侧枝血管。结论选择外环口平面以下可以最有效结扎曲张的精索静脉避免漏扎导致复发。     

Giant fibrolipoma of the spermatic cord

Fibrolipoma of the spermatic cord is extremely rare. A case of giant fibrolipoma of the right spermatic cord is reported here. A 68‐year‐old man noticed a mass in the right inguinal region, and was admitted to Shizuoka City Shimizu Hospital. Tumorectomy and right orchiectomy were performed. Grossly, the tumor was a well‐defined, yellowish white, solid, firm tumor measuring 13 × 10 × 9 cm. The tumor had a thin capsule. The tumor was attached to the right spermatic cord, and was remote from the right testis and epididymis. Microscopically, the tumor was composed of mature adipose tissue (40% in area) and collagenous fibrous tissue (60% in area). No lipoblasts were recognized, and on immunohistochemistry the tumor was negative for MDM2 and CDK4. Neither smooth muscle nor vascular proliferation was recognized. The tumor was diagnosed as giant fibrolipoma of the right spermatic cord. To the best of the author's knowledge, only two cases of fibrolipoma in the spermatic cord, scrotum, and testis have been reported in the English‐language literature.     

Primary paratesticular lymphoma: a report of 2 cases and review of literature

Non-Hodgkin lymphoma arising in the paratesticular organs without testicular involvement is rare. In most previously reported cases, the classification systems that were used are now outdated and/or immunologic studies were not done. We report the clinical and pathologic features of 2 cases of non-Hodgkin lymphoma arising in the epididymis and the spermatic cord. Patient 1 was a 35-year-old man who presented with a painless scrotal mass. Patient 2 was a 61-year-old man who presented with a right inguinal mass. Orchiectomy performed in both patients revealed a mass confined to the epididymis in patient 1 and to the spermatic cord in patient 2. Histologic examination in both cases revealed diffuse large cell lymphoma, and immunohistochemical studies supported B-cell lineage. Subsequent staging studies showed no other site of disease in patient 1 and an isolated mass anterior to the right psoas muscle in patient 2. Malignant lymphoma involving testicular adnexal structures without involvement of the testis is extremely uncommon. To our knowledge, only 6 cases confined to the epididymis and 12 cases confined to the spermatic cord have been reported previously.     

Asynchronous bilateral torsion of the spermatic cord in the newborn: a case report

Asynchronous bilateral torsion of the spermatic cord in the newborn is extremely rare. We report such a case in a 4-day-old boy with subsequent operative discovery of prior in utero torsion of the contralateral spermatic cord. The diagnosis was made by physical examination, transillumination test, color Doppler ultrasound, and confirmed by emergent surgical exploration. To our knowledge, the present case is the 6th case of asynchronous bilateral torsion of the spermatic cord in the English literature, and the first case in Korea.     

Occult gastric signet ring cell carcinoma presenting as spermatic cord and testicular metastases: “Krukenberg tumor” in a male patient

Krukenberg tumor is a well-known ovarian metastasis, usually of gastric signet ring cell carcinoma in female patients. Although gastric carcinoma is more frequent in men, to our knowledge, only few cases of counterpart testicular metastases have been described as yet. We report a 64-year-old patient who complained of right testicular pain. Right-sided orchiectomy was performed, and metastatic signet ring cell carcinoma of spermatic cord and testis was diagnosed through histological examination and immunohistochemistry. The following stomach biopsy confirmed the primary signet ring cell carcinoma in the stomach. This extremely rare form of metastatic dissemination resembles the Krukenberg tumor of ovaries. Immunohistochemical staining plays an important role in the differential diagnosis of spermatic cord enlargement.     

Recurrent varicoceles: causes and treatment using angiography and magnification assisted subinguinal varicocelectomy

Purpose

To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.

Materials and Methods

The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.

Results

Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.

Conclusion

Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.     

Xanthogranulomatous funiculitis and orchiepididymitis: report of 2 cases with immunohistochemical study and literature review

Two patients with xanthogranulomatous inflammation are described, one with involvement of the spermatic cord and the other with 1 testicle and epididymis affected. To our knowledge, only 12 cases of xanthogranulomatous orchiepididymitis have been reported previously, one of which also presented a xanthogranulomatous funiculitis. Clinically, our patients presented with spermatic cord enlargement (case 1) and chronic orchitis that did not respond to treatment with antibiotics (case 2). Histopathologically, both cases showed extensive xanthogranulomatous inflammation with numerous foamy macrophages that were associated with colonies of microorganisms suggestive of actinomyces in case 1. Additionally, Escherichia coli was cultured from the surgical specimen of case 2. The possible underlying pathology may be diabetes in case 1 and phlebitis associated with chronic orchitis in case 2. Differential diagnoses with other lesions that are rich in macrophages, such as malakoplakia, and those testicular neoplasms without serologic tumor markers are discussed.     

Primary lymphoma of the spermatic cord: a case report and review of the literature

Primary lymphomas of the spermatic cord are extremely rare. To date, only 15 cases have been reported in the international literature. Herein, we report a new case of a primary lymphoma of the spermatic cord. A 73-year-old patient presented at the Urology Department, complaining of bilateral painful masses at the inguino-scrotal region. A computed tomography scan revealed spermatic cord tumor. A right inguinal orchidectomy was performed in order to establish a definitive diagnosis. Macroscopically, the tumor was restricted to the spermatic cord area, leaving unaffected the testis and the epididymis. The histopathological and immune-histological evaluation has indicated a diffuse large B-cell lymphoma. Postoperatively, the patient was investigated thoroughly but no further signs of the disease were found.