作　　者： (陈国晓）; (张祥生）; (朱晓博）; (陈鑫）;

机构地区： 河南省人民医院、郑州大学人民医院泌尿外科,河南郑州450003

出　　处： 《中华男科学杂志》 2017年第9期798-803,共6页

摘　　要： 目的:总结"显微镜下精索内静脉腹壁下静脉分流术"治疗精索静脉曲张合并左肾静脉胡桃夹综合征的临床疗效及可行性。方法:回顾性分析河南省人民医院泌尿外科2014年6月至2017年2月施行"显微镜下精索内静脉腹壁下静脉分流术"30例患者的临床资料,随访并复查彩超、尿常规、精液常规资料。结果:30例患者手术均获得成功,术后6个月复查彩超静脉曲张治愈,精子浓度和(a+b级)精子活力术后6个月复查分别为(34.47±8.60)×10~6/ml和(63.54±9.58)%,较术前(19.90±8.97)×10~6/ml和(37.93±8.73)%明显改善(P<0.05)。24例镜下血尿中23例镜下血尿消失,1例减轻;14例尿蛋白阳性,患者尿蛋白均消失,阴囊疼痛等症状均消失,未出现明显并发症。结论:"显微镜下精索内静脉腹壁下静脉分流术"治疗精索静脉曲张合并胡桃夹综合征安全有效,创伤小,操作简单,适合在临床推广。 Objective： To investigate the clinical effect and feasibility of internal spermatic vein-inferior epigastric vein （ISV- IEV） bypass surgery in the treatment of varicocele complicated by left renal vein nutcracker syndrome （NCS）. Methods ： We retro- spectively analyzed the clinieal data about 30 cases of varicocele with leii renal vein NCS treated by ISV-IEV bypass surgery in our hos- pital from June 2014 to February 2017. We reviewed the follow-up data and results of ultrasonography, routine urianlysis and semen routine examination. Results： All the operations were successfully accomplished and postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. At 6 months after surgery, sperm concentration and the percentage of grade a ± b sperm were signifieantly improved （ [ 34.47 ± 8.60 ] x 10^6/ml and [ 63.54% ± 9.581% ） as compared with the baseline （ [ 19.90 ± 8. 97] xl0^6/mland [37.93 ± 8.73 %） （P 〈0.05）. Hematuria was cured in 23 and alleviated inl of the 24 cases. Protein- uria disappeared in all the 14 cases, with neither scrotal pain symptoms nor obvious complications. Conclusion ： ISV-IEV bypass sur- gery, with its advantages of safety, efectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of varieocele with left renal vein NCS.

关 键 词： 精索静脉曲张 胡桃夹综合征 显微镜下精索内静脉 腹壁下静脉分流术