[1]吴迪 朱文博 张宝勋*.神经外科显微镜在显微精索静脉曲张手术中的应用[J].中国微创外科杂志,2023,01(1):35-39.
　Wu Di,Zhu Wenbo,Zhang Baoxun..Application of Neurosurgical Operating Microscope in Microsurgical Varicocele Surgery[J].Chinese Journal of Minimally Invasive Surgery,2023,01(1):35-39.
点击复制

神经外科显微镜在显微精索静脉曲张手术中的应用()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年1期
页码:
35-39
栏目:
临床研究
出版日期:
2023-01-25

文章信息/Info

Title:
Application of Neurosurgical Operating Microscope in Microsurgical Varicocele Surgery
作者:
吴迪 朱文博 张宝勋*
(平凉市第二人民医院泌尿外科，平凉744000)
Author(s):
Wu Di;  Zhu Wenbo;  Zhang Baoxun.
Department of Urology, Second People’s Hospital of Pingliang, Pingliang 744000, China
关键词:
精索静脉曲张;  神经外科显微镜;  显微精索静脉曲张手术; 精索静脉结扎术
Keywords:
Varicocele; Neurosurgical microscope; Microvaricocele surgery; Varicocele ligation
文献标志码:
A
摘要:
目的探讨神经外科显微镜在显微精索静脉曲张手术中的应用价值。方法2018年7月~2021 年11月对63例精索静脉曲张行外环口下显微精索静脉结扎术，在放大5~10倍神经外科显微镜下逐一结扎离断精索内静脉，保留精索内淋巴管和动脉，如遇曲张明显的精索外静脉及输精管静脉一并结扎，不拖出睾丸，引带静脉不予处理。结果所有患者均做左侧，单侧手术时间60~110 min，(78.9±11.5)min。1例术中损伤到睾丸动脉，由于患者存在动脉分支，未做进一步处理。住院时间(3.8±0.6)d，住院费用(4006.36±236.56)元。2例出现阴囊水肿，术后2周左右消失。术后1年复查精液常规，精子浓度、精子数、正常形态精子率、精子前向运动率、配偶自然怀孕率均较术前明显升高(P<0.05)；术后1年DNA碎片率、阴囊疼痛评分、精索静脉内径较术前明显降低(P<0.05)。63例术后随访1年，复查彩超未发生睾丸萎缩、睾丸鞘膜积液等并发症，1例精索静脉曲张复发。结论神经外科显微镜下精索静脉结扎术可以较彻底结扎曲张的静脉，保护动脉及淋巴管，顺利完成手术。
Abstract:
ObjectiveTo summarize the clinical application of neurosurgical microscope in the operation of microvaricocele surgery.MethodsFrom July 2018 to November 2021, 63 patients with varicocele were treated with microligation of varicocele under the outer ring. The internal spermatic vein was ligated one by one under a neurosurgical microscope with a magnification of 5-10 times, and the internal lymphatic vessels and arteries of the spermatic cord were preserved. In case of varicocele, the external varicocele and vas deferens were ligated together without testicular traction and treatment of the leading vein. ResultsAll the patients were operated on the left side. The unilateral operation time was 60-110 min (mean, 78.9±11.5 min). The testicular artery was injured during operation in 1 case, and no further treatment was given because of the presence of arterial branches. The hospitalization time was (3.8±0.6)d, and the hospitalization cost was (4006.36±236.56) yuan. Scrotal edema happened in 2 cases and disappeared at 2 weeks after operation.One year after operation, semen routine examination showed that the sperm concentration, sperm count, proportion of normal sperm morphology, forward sperm motility and natural pregnancy rate were significantly higher than those before operation (P<0.05), while the DNA fragmentation rate, scrotal pain score and spermatic vein diameter significantly decreased at 1 year after operation (P<0.05). The 63 patients were followed up for 1 year.No complications such as testicular atrophy or testicular hydrocele were found by color Doppler ultrasonography. Varicocele recurred in 1 case. ConclusionVaricocele ligation under neurosurgical microscope can completely ligate the varicocele, protect the arteries and lymphatic vessels, and complete the operation successfully.

参考文献/References:

[1]郭应禄,李宏军,主编.男性不育症.北京:人民军医出版社,2003.275-291.
[2]白刚,李宏军.男性不育伴精索静脉曲张的诊治进展.生殖与避孕,2012,32(6):398-401．
[3]Mehta A, Goldstein M. Microsurgical varicocelectomy: A review. Asian J Androl,2013,15(1):56-60.
[4]《精索静脉曲张诊断与治疗中国专家共识》编写组.精索静脉曲张诊断与治疗中国专家共识.中华男科学杂志,2015,21(11):1035-1042.
[5]张恒,吴海啸,徐旻,等.腹腔镜下2种精索内静脉高位结扎术式的临床效果比较.中国微创外科杂志,2017,17(6):527-530.
[6]阮衍泰,郜亮,徐元诚.精索静脉曲张致男性不育的机制研究.中国男科学杂志,2010,24(12):66-69.
[7]Peng J, Zhang Z, Cui W, et al. Spontaneous pregnancy rates in Chinese men undergoing microsurgical subinguinal varicocelectomy and possible preoperative factors affecting the outcomes. Fertil Steril,2015,103(3):635-639.
[8]Ficarra V, Crestani A, Novara G, et al. Varicocele repair for infertility: what is the evidence? Curr Opin Urol,2012,22(6):489-494.
[9]Masson P， Brannigan RE. The varicocele. Urol Clin North Am,2014,41(1):129-144.
[10]李宏军.男性不育伴精索静脉曲张的治疗策略.中华男科学杂志,2018,24(3):195-198.
[11]李宏军.精索静脉曲张手术后患者的管理策略.中华泌尿外科杂志,2020,41(4):247-250.
[12]苏剑锋,张炎,杨晓健,等.显微镜下两种入路治疗精索静脉曲张引起的阴囊疼痛疗效对比.中华腔镜泌尿外科杂志(电子版),2017,11(1):55-58.
[13]黄剑华,钟羽翔,赵朋朋,等.经腹股沟和经腹股沟下途径显微镜精索静脉结扎术的疗效对比.中华腔镜泌尿外科杂志(电子版),2021,15(1):47-50.
[14]Grober ED, O’Brien J, Jarvi KA, et al. Preservation of testicular arteries during subinguinal microsurgical varicocelectomy: Clinical considerations. J Androl,2004,25(5):740-743.
[15]赵亮宇,田汝辉,黄煜华,等.精索静脉曲张与精索脉管解剖的相关性.中华医学杂志,2017,97(16):1244-1247.
[16]宫满成,袁润强.钳扎法在显微镜下腹股沟下精索静脉结扎术中的应用.中国微创外科杂志,2020,20(8):713-716.

备注/Memo

备注/Memo:
*通讯作者，Email：296417478@qq.com
更新日期/Last Update: 2023-04-23