精索静脉曲张不育患者精索静脉血精浆中锌和镉的测定及意义

用原子吸收光谱法 ( AAS)测定 1 8例精索静脉曲张 ( VC)不育患者和 1 4例正常生育的斜疝和或鞘膜积液患者外周静脉血、精索静脉血、精浆中的 Zn和 Cd的含量。结果表明 :精索静脉曲张不育患者精索静脉血和精浆中 Cd含量较对照组明显增高 ( P<0 .0 1 )、而精浆中的 Zn含量较对照组明显减低 ( P<0 .0 1 )。此外 ,其精索静脉血和精桨中 Cd/Zn比值与对照组也有显著性差异 ( P<0 .0 1 )。提示 Cd的增高可能是导致精索静脉曲张不育的原因之一。     

INHIBIN B LEVELS IN PERIPHERAL VEIN DO NOT CORRELATE WITH INHIBIN B LEVELS IN THE SPERMATIC VEIN IN ADOLESCENTS WITH VARICOCELE

This study was conducted to evaluate the inhibin B with FSH and LH levels on spermatogenesis in varicocele patients. The study group consisted of 10 adolescent with left idiopathic varicocele of grade II and III. Blood specimens were obtained from dilated spermatic vein and peripheral vein simultaneously. Peripheral samples were also collected from 7 healthy children as controls. Inhibin B was measured with ELISA inhibin B kits. FSH and LH were analyzed by radioimmunoassay techniques. The results were analyzed using Mann-Whitney U and Spearman's rank tests. A value of p < 0.05 was considered significant. Peripheral FSH, LH and inhibin B levels were the same in the study and control group (p > 0.05). Mean inbibin B levels of spermatic vein were significantly higher than the control and peripheral blood of the study groups (p < 0.05). FSH, LH, and inhibin B levels correlated poorly each other (p > 0.05). Preoperative serum inhibin B concentration could not reliably predict a response to varicocelectomy, but the increase in inhibin B levels after treatment might suggest an improvement in testicular function.     

精索静脉高位结扎术对抗精子抗体、精子顶体酶活性及精子数量、活动力的影响

目的探讨精索静脉曲张患者在精索静脉高位结扎术前、后精液中抗精子抗体、精子顶体酶活性及精子数量、活动力的变化。方法选取精索静脉曲张患者35例。用混合抗球蛋白凝集法(MAR)、改良的Kennedy法测定术前和术后3～6个月精液中抗精子抗体、精子顶体酶活性及精子计数、活动力(a及b级活动力精子的百分率)测定。结果精索静脉高位结扎术后患者精液中抗精子抗体有下降、精子顶体酶活性较术前明显增高、精子数量增加、活动力升高。结论精索静脉高位结扎术对精索静脉曲张患者精液中抗精子抗体的下降、精子顶体酶活性的提高、精液质量的提高有帮助。     

经脐单孔无气腹腹腔镜下治疗精索静脉曲张性不育的效果观察

目的了解经脐单孔法无气腹腹腔镜精索静脉高位结扎术治疗精索静脉曲张性不育的临床疗效。方法选取精索静脉曲张患者40例,行经脐单孔法无气腹腹腔镜精索静脉高位结扎术,观察患者的手术时间、术后住院天数、术后并发症及术后3个月时精液质量改善情况。结果 40例患者术后均顺利完成,无明显出血影响手术操作,无严重手术并发症,术后阴囊坠胀不适感均消失或减轻,阴囊触诊扩张迂曲的静脉明显缩小,Valsava试验阴性。其中单侧患者手术时间为18~25 min,平均24.2 min;双侧患者手术时间为35~47 min,平均36.7 min。平均住院时间2.4 d。经过3个月随访,无复发病例,术后3个月复查精液常规,精液质量明显改善,术后精子密度、活率、（A＋B）级精子比例与术前比较差异有统计学意义（P〈0.05）。结论经脐单孔腹腔镜精索静脉高位结扎术可作为治疗精索静脉曲张性不育的一种可选术式,可取得良好的临床疗效。     

Expression of NOS isoforms in internal spermatic veins of infertile men with varicocele

Although varicocele is a relatively common entity encountered in the evaluation of infertile men, the exact pathophysiology still remains unclear. Recently, as previously widely investigated in various parts of human circulatory system, nitric oxide synthase (NOS) and its product, nitric oxide (NO) have been thought to play a role in the development of varicocele and thus male infertility. In this study, we determined the concentration of NO metabolite and the expression of NOS isoforms in the internal spermatic (ISV) and superficial branch of inferior epigastric veins of infertile men with varicocele. The study included 60 infertile men with clinically unilateral or bilateral varicocele. Expression of inducible and endothelial NOS (iNOS and eNOS) isoforms were investigated in tissue arrays of internal spermatic and superficial branch of inferior epigastric veins with immunohistochemistry. NO metabolite (nitrite) levels were measured using the calorimetric method. A significantly higher expression of eNOS was observed in the varicose veins (mean score: 2.25 and 1.55, respectively; p?=?0.0001). However, statistically, there was no significant difference for expression of iNOS between varicose and control veins (p?=?0.094). The nitrite concentration and NOS expression were not found to be correlated with clinical variables (varicocele grade, maximum varicose vein diameter, and sperm concentration, motility, and morphology) (p?>?0.05). As a result, the significantly higher expression of eNOS in ISV may be responsible for the development of varicocele, although this finding is not accompanied by an increase in NO concentration. Still, the pattern of the relationship between varicocele and increased eNOS expression warrants further investigation.     

三种术式治疗精索静脉曲张的临床疗效比较

目的 探讨腹腔镜下精索静脉高位结扎术、改良Palomo术和传统开放手术(经腹股沟管精索静脉结扎术)治疗精索静脉曲张的临床疗效及差别.方法 将135例精索静脉曲张手术患者按照随机数字表法分为三组,腹腔镜下精索静脉高位结扎术组(A组,50例)、改良Palomo术组(B组,70例)和传统开放手术组(C组,15例),对三组患者的手术时间、住院时间、手术费用,术前、术后1、6、12个月的精液质量进行比较,并追踪18个月内患者精索静脉曲张复发、配偶临床妊娠结果 及睾丸萎缩的发生情况.结果 三组患者在单侧手术时间、住院时间方面比较差异无统计学意义(P>0.05);住院费用方面A组明显高于B、C组(P<0.05),而B、C组间比较差异无统计学意义(P>0.05);三组术后精液质量均较术前有显著提高(P<0.05),但组内术后1、6、12个月精液质量各参数比较差异无统计学意义(P>0.05).术后随访18个月,C组复发率13.3%(2/15),显著高于A组的0和B组的1.4%(1/70)(P<0.05),三组配偶临床妊娠率比较差异无统计学意义(P>0.05)[A组68.0%(34/50),B组68.6%(48/70),C组66.7%(10/15)].随访期间三组均无睾丸萎缩.结论 腹腔镜下精索静脉高位结扎术和改良Palomo术是治疗精索静脉曲张的安全、简单、有效的手术方式.对于单侧精索静脉曲张,改良Palomo术值得首先推荐;对于双侧和复发的精索静脉曲张,则可以优先考虑腹腔镜手术.

Abstract：

Objective To investigate the clinical therapeutic effectiveness of laparoscopic high ligation of spermatic vein method, modified Palomo procedure and ligating of spermatic vein via inguinal canal for varicocele. Methods All 135 patients with varicocele who underwent varicocele were divided into three groups by random number table method: laparoscopic high ligation of spermatic vein method group (group A, 50 cases), modified Palomo procedure group(group B, 70 cases) and ligating of spermatic vein via inguinal canal group (group C, 15 cases). The surgery time,the length of stay,the hospital expenses,and the quality of their semen were collected at different time points (preoperation, 1,6,12 months after operation) and assessed,the recurrence rate,the pregnant outcomes of their spouses and the testicle atrophy rate 18 months postoperation were followed-up. Results There was no significant difference in the surgery time and the length of stay among three groups (P> 0.05). But the hospital expenses in group A was significantly higher than that in group B and group C (P <0.05). The quality of their semen were all significantly increased after operation in three groups compared with that before operation (P<0.05). There was no significant difference in the key parameters of the quality of their after operation among three groups (P> 0.05). During the follow-up of 18 months, the recurrence rate in semen group C (13.3% ,2/15) was significantly higher than that in group A (0) and group B (1.4%, l/70)(P< 0.05). There was no significant difference in their spouses who were found to have clinical pregnant outcomes during follow-up [group A: 68.0%(34/50),group B:68.6%(48/70),group C:66.7%(10/15)](P> 0.05). No testicle atrophy happened during follow-up. Conclusions Laparoscopic surgery and modified Palomo procedure are safe,convenient and effective surgical techniques. Modified Palomo procedure is recommended for unilateral varicocele. Laparoscopic surgery has advantages for recurrent and bilateral varicocele.     

Expression of NOS isoforms in internal spermatic veins of infertile men with varicocele

Although varicocele is a relatively common entity encountered in the evaluation of infertile men, the exact pathophysiology still remains unclear. Recently, as previously widely investigated in various parts of human circulatory system, nitric oxide synthase (NOS) and its product, nitric oxide (NO) have been thought to play a role in the development of varicocele and thus male infertility. In this study, we determined the concentration of NO metabolite and the expression of NOS isoforms in the internal spermatic (ISV) and superficial branch of inferior epigastric veins of infertile men with varicocele. The study included 60 infertile men with clinically unilateral or bilateral varicocele. Expression of inducible and endothelial NOS (iNOS and eNOS) isoforms were investigated in tissue arrays of internal spermatic and superficial branch of inferior epigastric veins with immunohistochemistry. NO metabolite (nitrite) levels were measured using the calorimetric method. A significantly higher expression of eNOS was observed in the varicose veins (mean score: 2.25 and 1.55, respectively; p?=?0.0001). However, statistically, there was no significant difference for expression of iNOS between varicose and control veins (p?=?0.094). The nitrite concentration and NOS expression were not found to be correlated with clinical variables (varicocele grade, maximum varicose vein diameter, and sperm concentration, motility, and morphology) (p?>?0.05). As a result, the significantly higher expression of eNOS in ISV may be responsible for the development of varicocele, although this finding is not accompanied by an increase in NO concentration. Still, the pattern of the relationship between varicocele and increased eNOS expression warrants further investigation.     

腹腔镜手术与开放手术治疗双侧精索静脉曲张的对比

目的:探讨腹腔镜精索静脉高位结扎术治疗双侧精索静脉曲张的疗效。方法:本院收治的25例双侧精索静脉曲张患者随机分为两组,对照组12例采用开放手术,行开放性双侧精索静脉高位结扎,治疗组13例采用腹腔镜下双侧精索内静脉高位结扎术。观察并比较两组患者疗效。结果:两组手术均获成功,无并发症。治疗组平均手术时间短于对照组,差异有统计学意义(P0.05);治疗组的平均术中出血量和术后住院时间亦显著短于对照组(P0.01)。随访3个月～1年,两组患者均无复发,两组的症状改善率和精液改善率无明显差异(P0.05)。结论:腹腔镜手术治疗双侧精索静脉曲张安全、有效,患者创伤小、康复快,为手术治疗双侧精索静脉曲张提供了一种可选择的方法。     

小切口腹膜后精索静脉高位结扎治疗精索静脉曲张

[目的]了解采用小切口腹膜后精索静脉高位结扎的方法,对治疗精索静脉曲张的临床效果。[方法]本组65例均选择单纯的左侧精索静脉曲张病例,采用小切口腹膜后精索静脉高位结扎的方法施行手术,观察其临床治疗效果。[结果]采用小切口腹膜后精索静脉高位结扎的方法治疗精索静脉曲张,65例手术均获成功,精索静脉曲张完全消失或减轻,阴囊坠胀症状消失。[结论]该方法是一种有效治疗精索静脉曲张的微创手术方法,具有麻醉简单,创口小、恢复快、费用低的优点,适合在基层医院推广使用。     

盆腔封闭式循环化疗治疗妇科恶性肿瘤的实验研究

目的:探讨盆腔封闭式循环化疗的可行性及药代动力学变化。方法:将10只犬随机分为2组,对照组4只,行常规髂内动脉灌注化疗;实验组6只,行经皮盆腔封闭式循环化疗(化疗药物选用卡铂)结合血液灌流。定时检测两组髂内静脉、外周血液的血药浓度及实验组血液灌流后的血药浓度。结果:对照组和实验组髂内静脉血药浓度均在10 min达峰值,分别为(5 497.71±601.80)ng/ml、(5 151.19±558.60)ng/ml,两组比较无统计学差异(P>0.05)。对照组20 min、30 min、40min、50 min、60 min血药浓度迅速下降,分别为(2 887.44±259.50)ng/ml、(1 512.56±147.90)ng/ml、(889.87±92.40)ng/ml、(733.76±72.80)ng/ml、(571.46±47.60)ng/ml;而实验组仍保持较高浓度,分别为(5 121.31±530.20)ng/ml、(4998.57±511.40)ng/ml、(4 018.30±378.90)ng/ml、(2 894.47±285.00)ng/ml、(2 114.18±189.70)ng/ml,两组各时段血药浓度比较有统计学差异(P<0.01)。两组药时曲线下面积(AUC)分别为(110 943.02±9 056.78)(ng/ml.min)、(229430.11±2 154.07)(ng/m.min),有统计学差异(P<0.01)。对照组10 min、20 min、30 min、40 min、50 min、60 min外周血药浓度分别为(4 984.94±468.80)ng/ml、(3 387.83±325.70)ng/ml、(1 312.48±126.60)ng/ml、(1 089.59±97.70)ng/ml、(771.07±73.50)ng/ml、(521.33±48.30)ng/ml,实验组分别为(20.54±2.40)ng/ml、(37.01±3.50)ng/ml、(50.99±4.80)ng/ml、(88.63±9.10)ng/ml、(125.72±12.80)ng/ml、(134.88±12.30)ng/ml,两组比较有统计学差异(P<0.01)。实验组血液灌流后的血药清除率为(92.71±7.70)%。结论:盆腔封闭式循环化疗是一种可行的技术,与常规髂内动脉灌注化疗相比,不仅可以在较长时间内增加局部血药浓度,还可以降低外周的血药浓度,减少毒副作用。     

Testicular Steroids in Spermatic and Peripheral Veins After Single Injection of Hcg in Patients With Varicocele

To determine the function of Leydig cells in patients with varicocele, hCG-stimulated levels of progesterone (Prog), 17α-Hydroxy-4-pregnene-3,20-dione (17OHP), 4-Androstene-3,17-dione (A-dione), testosterone (T), and estradiol-17β (E₂) in both spermatic and peripheral veins were measured. Seventy-two patients with idiopathic varicocele were divided into four groups: patients in group 1 were untreated, whereas patients in groups 2, 3, and 4 were given a single i.m. injection of 10,000 IU hCG 24 h, 96 h, and 168 h before surgery, respectively. In the spermatic and peripheral veins, levels of Prog, 17OHP, and E₂ showed peaks at 24 h, whereas levels of A-dione and T showed peaks at 96 h. Significant increases in the ratios of spermatic veins 17OHP to A-dione and 17OHP to T, and a significant decrease in the ratio of T to E₂, was found 24 h following hCG treatment. These results demonstrate that, following hCG injection, there is a transient inhibition of testicular C_17–20-lyase activity, probably mediated by E₂, even in subfertile males with varicocele.     

Induction of Renin-Angiotensin System in Human Testis In Vivo

To better understand the local renin-angiotensin system in Leydig cells of the human testis, the plasma renin activity (PRA) and plasma concentration of angiotensin II (PAII) in the left internal spermatic vein (ISV) and cubital vein (CV) were measured at the time of surgical repair of varicocele in 27 patients. Fourteen of the patients were given a single i.m. injection of hCG (10,000 IU/m²) 4 days before the operation, whereas the remaining 13 were not treated. Although the mean PRA or PAII levels in the CV in the treated and nontreated groups were similar, both levels in the ISV in the treated group were significantly higher than in the nontreated group (p < 0.05). For PAII levels in the treated group, nine of 11 patients with an increased PRA level showed significantly higher levels than the normal peripheral PAII value. The serum testosterone levels in the same ISV were also much higher in the treated group than in the nontreated group (p < 0.001). These results suggested the possibility that sex steroids might influence the renin-angiotensin system in Leydig cells.     

Significant improvement of sperm DNA quality after microsurgical repair of varicocele

Varicocele is currently the most common irregularity identified in males that is associated with impaired spermatogenesis. It primarily presents in the form of decreased sperm count and motility, abnormal morphology, and significantly increased sperm DNA fragmentation. Several studies have shown that surgical repair improves semen parameters and increases the odds of spontaneous pregnancy. However the exact effect of surgical repair treatment remains controversial. Therefore, the aim of our study was to evaluate the effectiveness of microsurgical repair by comparing common semen parameters and sperm DNA fragmentation index (DFI). We evaluated infertile men (n?=?19) who underwent microsurgical subinguinal varicocelectomy for treatment of clinical varicocele before and 3 months after surgery. Normozoospermic men (n?=?19) were considered as the normal control group. Semen parameters improved significantly after surgery when compared with that before surgery, but still significant differences with the normal control group were observed. In comparison, sperm DNA integrity improved significantly after surgery (percentage DFI decreased from 28.4?±?15.6% before surgery to 22.4?±?12.9%, at 3 months post surgery) to similar levels as the normal control group. These results suggest that microsurgical repair may be considered as a treatment option in infertile men with palpable varicocele.     

妊娠期糖尿病与患者血硒水平及谷胱甘肽过氧化物酶活性的关系

目的:探讨妊娠期糖尿病(GDM)与血硒水平及谷胱甘肽过氧化物酶活性之间的关系。方法:检测GDM患者30例(GDM组)和正常妊娠者30例(对照组)血硒水平及全血谷胱甘肽过氧化物酶(GSH-PX)活性。结果:①GDM组血硒水平为(0.0620±0.0224)mg/L,GSH-PX活性为(68.20±15.91)活力单位;对照组血硒水平为(0.0783±0.0209)mg/L,GSH-PX活性为(80.36±12.68)活力单位,两组比较,差异有统计学意义(P<0.01)。②孕妇血硒水平与GSH-PX活性呈显著正相关(r=0.714,P<0.001)。结论:妊娠期糖尿病患者血硒水平与GSH-PX活性下降可能与妊娠期糖尿病的发病有关。     

Ⅲ度精索静脉曲张患者术后性激素的变化

目的分析Ⅲ度精索静脉曲张患者手术前后性激素的改变,探讨手术治疗精索静脉曲张的疗效。方法 2009年1月至2011年12月河源市人民医院收治的108例Ⅲ度精索静脉曲张患者,患者平均年龄28.3岁(18～36岁),术前抽血测血清睾酮(Testo)、促卵泡成熟激素(hFSH)、促黄体生成激素(hLH)、催乳素(Prol)水平,所有患者均行精索静脉高位结扎术,术后半年抽血复查外周血清性激素;统计分析手术前后患者性激素水平的变化。正常组为具有正常生育能力的健康男性35例,平均年龄26.8岁(19～37岁),同样抽血测血清性激素水平。结果患者术前血清Testo值低于正常组,而hLH、hFSH、Prol值较正常组明显升高(P<0.05),术后患者血清T、DHT值较术前升高,而hLH、hFSH、Prol值较术前降低,术前术后患者性激素比较有统计学差异(P<0.05)。结论Ⅲ度精索静脉曲张能引起性激素的改变,精索静脉高位结扎术后性激素水平明显改善。     

单孔腹腔镜精索静脉高位结扎术153例临床报告

目的总结单孔三通道腹腔镜手术治疗原发性精索静脉曲张的手术经验。方法系统回顾分析我院2006年至2009年采用单孔腹腔镜精索静脉高位结扎术治疗的153例患者病例资料。结果 153例手术中,除1例复发外,均无远期并发症发生,随访6～12月术后恢复良好。结论单孔三通道腹腔镜精索静脉高位结扎术是一种较理想的手术方式,值得临床推广应用。     

人工流产与复发性自然流产蜕膜淋巴细胞亚群FAS表达的研究

目的:研究不明原因复发性流产(RSA)患者外周血、蜕膜组织T细胞、NK细胞数量,NK细胞亚群数量及FAS抗原的表达,探讨其在RSA中的作用。方法:选取确定妊娠并难免流产者26例为实验组,25例正常妊娠行人工流产者作为对照组,用流式细胞仪检测两组外周血和蜕膜组织T细胞、NK细胞数量,NK细胞亚群数量及FAS抗原的表达。结果:①对照组外周血T细胞和NK细胞,蜕膜组织T细胞和NK细胞分别为(65.54±11.91)%、(12.26±6.46)%、(5.63±5.10)%、(56.50±19.80)%;实验组分别为(42.41±10.03)%、(12.24±6.40)%,(5.62±4.74)%、(60.14±21.52)%;两组差异无统计学意义(P>0.05)。②对照组外周血CD3-CD56+CD16+和CD3-CD56+CD16-细胞,蜕膜组织CD3-CD56+CD16+和CD3-CD56+CD16-细胞分别为(65.54±11.91)%、(6.06±3.05)%,(2.84±1.59)%、(83.79±6.02)%;实验组分别为(74.93±11.42)%、(5.58±2.72)%,(5.36±4.76)%、(74.12±11.32)%;P值分别是0.014,0.592,0.031,0.001,除外周血CD56+CD16-细胞两组无差异外,其余3组差异有统计学意义。③对照组外周血CD3-CD56+CD16+FAS和蜕膜组织CD3-CD56+CD16-FAS表达分别为(49.15±9.77)%和(4.97±2.32)%;实验组分别为(38.21±9.42)%,(9.59±6.42)%;P值分别是0.001、0.004,差异有统计学意义。结论:FAS/FASL系统可能是外周血和蜕膜组织NK细胞亚群凋亡的主要途径之一。     

成年人胡桃夹现象与精索静脉曲张相关性临床研究

目的 探讨成年人胡桃夹现象(NCP)与精索静脉曲张的相关性及意义.方法 回顾性分析226例以无症状性血尿和(或)直立性蛋白尿(微量白蛋白尿)就诊的并经彩色多普勒超声诊断明确的成年NCP患者的临床特点,以左肾静脉受压前后比值≥2为诊断NCP现象标准,将其中184例男性NCP患者作为研究组,将同期参加体检且与之年龄匹配的男性156例,经彩色多普勒超声检查无NCP作为对照组,检查两组精索静脉曲张发病率,并比较.在研究组,详细检查NCP相关指标,采用Logistic回归分析研究NCP与精索静脉曲张的相关性.结果 研究组左侧亚临床型精索静脉曲张患者22例,精索静脉曲张患者47例,总发病率37.50%(69/184);对照组亚临床型精索静脉曲张患者13例,精索静脉曲张患者8例,总发病率13.46%(21/156).两组比较差异有统计学意义(P=0.000).研究组左侧亚临床型精索静脉曲张患者脊柱左侧肾静脉内径(8.41±0.11)mm,脊柱前肾静脉内径(3.65±0.11)mm,二者比值2.31±0.06.肠系膜上动脉(SMA)与腹主动脉(AA)夹角(15.95±0.59)°;左侧精索静脉曲张患者脊柱前肾静脉内径(3.43±0.08)mm,脊柱左侧肾静脉内径(8.72±0.14)mm,二者比值2.54±0.08,SMA与AA夹角(14.54±0.53)°.在研究组,Logistic回归分析表明SMA与AA夹角越小、脊柱左侧肾静脉内径越大、年龄越大,男性NCP患者越容易并发左侧精索静脉曲张(P=0.001).结论 成年男性NCP患者左侧精索静脉曲张发病率显著高于同年龄段非NCP成年男性,这表明在成年男性中,NCP是精索静脉曲张的一个重要病因,二者密切相关.     

精索静脉曲张对青春期大鼠生精细胞凋亡的影响

目的研究实验性精索静脉曲张对青春期大鼠生精细细胞凋亡的影响,探讨精索静脉曲张影响睾丸生精功能的机制。方法通过部分结扎左肾静脉建立青春期大鼠左侧精索静脉曲张模型;用原位末端脱氧核苷酸转移酶标记法检测睾丸生精细胞凋亡。结果曲张组的细胞凋亡指数显著高于假手术对照组(P<0.001),且双侧睾丸组织均见大量生精细胞凋亡。结论实验性精索静脉曲张所引起的双侧睾丸生精细胞凋亡增加,可能是精索静脉曲张影响睾丸生精功能的机制之一。     

武警官兵胡桃夹现象致精索静脉曲张的超声研究

目的:探讨超声诊断武警官兵因胡桃夹现象导致精索静脉曲张的应用价值。方法:总结分析近5年来确诊精索静脉曲张的306例武警官兵中,同时出现血尿、蛋白尿的46例进行左肾静脉彩色多普勒超声检查的资料。结果:46例中有10例超声检查提示胡桃夹现象,左肾静脉受压程度不一,狭窄前出现不同程度的管腔扩张。结论:精索静脉曲张在部队官兵中发病率不低,对于其中出现血尿、蛋白尿的患者,应当行左肾静脉彩色多普勒超声检查,判断其是否存在胡桃夹现象,为临床治疗精索静脉曲张提供准确的影像学资料。