腹股沟下途径显微技术精索静脉输精管同时结扎1例报告并文献复习

目的：探讨显微技术下同时施行输精管和精索静脉结扎术的安全性和有效性.方法：患者,39岁,因计划生育政策需行输精管结扎,患者合并双侧精索静脉曲张（右侧Ⅱ度,左侧Ⅰ度）以及右阴囊坠胀不适,显微技术下同时施行输精管和精索静脉结扎术.结果：1、3、6个月分别复诊,患者无阴囊不适感;触诊以及阴囊超声未见阴囊及其内容物水肿征象,右侧精索静脉无曲张复发,无睾丸萎缩.3个月辅助检查精液中无精子.结论：显微技术下同时施行输精管结扎和精索静脉结扎术,既保护淋巴管、睾丸动脉,又可以明确保留输精管脉管系统的完整性,保证了睾丸的充分的静脉回流,安全、有效.

Simultaneous Microsurgical Subinguinal Vasectomy and Varicocelectomy:a Case Report and Review of the Literature

Objective：We investigate the effect and safty of simultaneous microsurgical subinguinal vasectomy and varicocelectomy. Methods：A 39-years old male, bilateral varicocele （left I , right II ） with right lesticular pain, request vasectomy. Under the operating microscope （10×）, in the right side,cremasteric vein were identified and ligated. Arteries is microscopically dissected free of all surrounding tissue. All internal spermatic veins are ligated with 5-0 suture, and lymphatics were preserved. The deferential vessels were carefully dissected and pre Served. The vas was then double ligated and transected, through the serotom approach, the left vas deferens was treated similar to the right side. Results：Overall , 2 testicular arteries and 3 lymphatics were preserved, 9 internal spermatic veins and 1 cremasteric veins were ligated. The follow-up was 3 month and 6 month respectively after surgery. No complications episodes of testicular atrophy, vasectomy failure, varicocelectomy recurrences, and scrotal uncomfort were found. Conclusions： Microsurgical varicocelectomy allows the identification of the artery, tiny vein and lymphatic. Men presenting for vasectomy with palpable and symptomatic varicoceles could benefit from simultaneous microsurgical vasectomy and varicocelectomy.