精索静脉曲张手术疑似失败一例报告及再手术指证探讨

本文报告一例精索静脉曲张手术疑似失败病例的处理经过。患者双侧精索静脉曲张(左侧Ⅲ度,右侧Ⅱ度)伴局部疼痛不适及精液质量严重异常,行腹腔镜双侧精索静脉高位结扎术,术后2个月自觉局部坠胀、疼痛症状明显缓解,但双侧阴囊的迂曲较术前更加明显,疑似手术失败并再次入院。经临床和实验室检查后,发现患者无明确手术失败证据,选择对症治疗而避免再次手术。观察等待3个月后复诊,患者临床表现(鞘膜积液及坠胀感)减轻,实验室检查精液质量改善,超声检查乏氏动作后双侧精索静脉未见返流,双侧睾丸鞘膜未见明显积液,进一步确诊术后症状为术后暂时性侧枝循环建立不佳所致,而这种情况在同类手术中比较常见。综合本病例及文献报道,我们建议要严格掌握再手术的指证:明确的复发征象(与体位相关的精索静脉曲张及血液返流);患者的原始诉求(疼痛不适、精液质量异常)仍然存在且无改善。难以判断者,建议观察等待,以避免不必要的再次手术。通常术后应观察3~6个月再进行综合判定。     

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