显微精索静脉结扎术开展5年经验与特殊情况处理(附357例报告)
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摘要
目的本研究拟分析、总结我们开展显微镜下精索静脉结扎术5年来对术前患者的选择以及术中诸如动静脉难以分辨、解剖变异等特殊情况的处理经验。方法回顾2010年9月至2015年6月开展的显微镜下精索静脉结扎术的病例资料,分析青少年期患者的手术选择,并分析手术期间遇到部分诸如经低位(阴囊上方切口)手术、网状或蔓状静脉丛分离困难、动静脉镜下难以分辨、动静脉破损出血视野模糊、纤细血管及淋巴管难以分辨和手术区域解剖变异(先天性或既往手术后导致的)等较特殊的病例。结果 5年间共357例精索静脉曲张患者接受了显微镜下精索静脉结扎术,经总结出针对上述特殊的病例诸如使用扩张血管药物促进分辨、不同方法处理动静脉破损、仔细处理蔓状静脉丛包绕的动脉等手术技巧以及术后阴囊肿胀、疼痛的等并发症的处理经验。结论显微镜下精索静脉结扎术是治疗精索静脉曲张患者的良好选择,术前的充分告知和术中的精细操作、冷静处理突发情况是决定手术预后的关键。
Objective Although microsurgical varicocelectomy shows obvious advantages in lower recurrence and complication for varicocele patients, it is still full of challenges for surgeons to select the suitable patients and deal with the special circumstances, such as confusing of artery and veins, anatomical variation, etc. In this study, we summarized and reported our experiences on the treatment of special circumstances for microsurgical varicocelectomy. Methods We retrospectively analyzed clinical data of all varicocele patients from September, 2010 to June, 2015, and summarized some experiences on microsurgical varicocelectomy, including surgical selection on the patients of adolescence and subclinical stage, operation through above scrotum cut, dissection on reticular and pampiniformis venous plexus, discrimination of artery and veins, blur of visual field after small vessels damaging, discrimination of small lymphatic vessel and venous, geneogenous and postsurgeric anatomical variation in operative region in all patients. Results Total of 357 varicocele patients underwent microsurgical varicocelectomy during five years. We summarized some surgical skills targeting on special circumstances in microsurgical varicocelectomy, for example, pimobendane using for discrimination of artery and veins, different treatments for small vessels damaging, microprocessing on artery encysted by pampiniformis venous plexus, and processed experience as surgical complications as postsurgical scrotal swelling and pain. Conclusion Microsurgical varicocelectomy is a favorable selection for treatment of varicocele patients. Sufficient preoperative communication, refined intraoperative manipulation and hardheadedly handling with emergency situation are the key points for improving prognosis of patients.
Objective Although microsurgical varicocelectomy shows obvious advantages in lower recurrence and complication for varicocele patients, it is still full of challenges for surgeons to select the suitable patients and deal with the special circumstances, such as confusing of artery and veins, anatomical variation, etc. In this study, we summarized and reported our experiences on the treatment of special circumstances for microsurgical varicocelectomy. Methods We retrospectively analyzed clinical data of all varicocele patients from September, 2010 to June, 2015, and summarized some experiences on microsurgical varicocelectomy, including surgical selection on the patients of adolescence and subclinical stage, operation through above scrotum cut, dissection on reticular and pampiniformis venous plexus, discrimination of artery and veins, blur of visual field after small vessels damaging, discrimination of small lymphatic vessel and venous, geneogenous and postsurgeric anatomical variation in operative region in all patients. Results Total of 357 varicocele patients underwent microsurgical varicocelectomy during five years. We summarized some surgical skills targeting on special circumstances in microsurgical varicocelectomy, for example, pimobendane using for discrimination of artery and veins, different treatments for small vessels damaging, microprocessing on artery encysted by pampiniformis venous plexus, and processed experience as surgical complications as postsurgical scrotal swelling and pain. Conclusion Microsurgical varicocelectomy is a favorable selection for treatment of varicocele patients. Sufficient preoperative communication, refined intraoperative manipulation and hardheadedly handling with emergency situation are the key points for improving prognosis of patients.
引文
1胡克清,战立龙,王静,等.外环下显微镜外科治疗精索静脉曲张的临床研究(附26例报告).泌尿外科杂志·电子版2015;7(2):50-52
2 卓晖,魏仁波,李强.显微镜辅助下精索静脉曲张结扎术手术疗效及体会(附32例报告).四川医学2015;36(4):549-550
3 Mohammadi A,Ghasemi-Rad M,Mladkova N,et al.Varicocele and Nutcracker Syndrome:sonographic Findings.Journal of Ultrasound in Medicine 2010;29(8):1153-1160
4 平萍,陈向锋,王鸿翔,等.显微外科技术在男性不育症治疗中的应用及疗效分析.中国计划生育和妇产科2015;7(1):20-22
5 曹志强,王阳.不同手术方式治疗精索静脉曲张的回顾性分析(附658例报告).现代泌尿外科杂志2014;19(10):658-661,677
6 Nikitin OD,Bazalitskaia SV.Efficiency of surgical treatment of varicocele for restoration of reproductive function.Klin Khir 2013;(10):63-66
7 Park YW, Lee JH. Preoperative predictors of varicocelectomy success in the treatment of testicular pain.World J Mens Heahh 2013;31(1):58-63
8 Ding H,Tian J,Du W,et al.Open non-microsurgical,laparoscopic or open microsurgical varicocelectomy for male infertility:a meta-analysis of randomized contro11ed trials.BJU Int 2012;110(10):1536-1542
9 蔡华戈.低位显微外科与腹腔镜精索静脉结扎术治疗精索静脉曲张性不育的临床疗效对比.医药前沿2014;(6):206
10曹礼庭,顾鹏,张敏惠,等.彩色多普勒超声对亚临床型、临床型精索静脉曲张内径及反流检测的临床意义.临床超声医学杂志2003(3):161~163.
11 赵斌,吴荣德,于启海,等.儿童精索静脉曲张患病情况的调查.中华小儿外科医杂志2005;26(3):132-134
12 Dohle GR,Glassberg KI.How common are varicocoeles?New data on the prevalence in adolescence and new discussions.Andrology 2013;1(5):661-662
13 G?k?e A,Davarci M,Yal?inkaya FR,et al.Hereditary Behavior of Varicocele.J Androl 2010;31(3):288-290
14 刘毅东,叶惟靖,吴旻,等.显微镜下精索静脉结扎术治疗青春期精索静脉曲张.临床小儿外科杂志2015;14(1):45-47
15 吴阶平.吴阶平泌尿外科学.济南:山东科学技术出版社,2004:1951
16 邓志海,潘斌,洪余德,等.显微镜手术联合麒麟丸治疗精索静脉曲张致弱精子症.中华实验外科杂志2015;32(6):1454-1455
17 Ozturk MI,Koca O,Keles MO,et al.The impact of unilateral experimental rat varicocele model on testicular histopathology,Leydig cell counts,and intratesticular testosterone levels of both testes.Urol J 2013;10(3):973-980
18朱宏,陈斌,吕逸清,等.手术治疗对精索静脉曲张不育患者精浆瘦素水平及精子凋亡率的影响.中国男科学杂志2013;27(11):19-22,26
19 李海峰,赵洪波,祝海.腹股沟下显微精索静脉结扎术、传统经腹股沟途径与腹腔镜精索静脉结扎术疗效对比研究.中国医刊2013;48(2):67-69
20 Mehta A,Goldstein M.Microsurgical varicocelectomy:a review.Asian J Androl 2013;15:56-60
21 江专新,覃云凌,于建红,等.局麻下显微外科曲张精索静脉结扎术疗效与安全性评价(附62例报道).中国男科学杂志2014;28(12):48-49
22 Cayan S,Shavakhabov S,Kadioglu A.Treatment of palpable varicocele in infertile men:a meta-analysis to define the best technique.J Androl 2009;30(1):33-40
23 Diegidio P,Jhaveri J K,Ghannam S,et al.Review of current varicocelectomy techniques and their outcomes.BJU Int 2011;108(7):1157-1172
24 Goldstein M,Gilbert BR,Dicker AP,et al.Microsurgical inguinal varicocelectomy with delivery of the testis:an artery and lymphatic sparing technique.J Urol 1992;148(6):1808-1811
25 吕坤龙,邬健斌,吴观土,等.腹股沟下显微精索静脉结扎术与腹膜后精索内静脉高位结扎术疗效比较.新医学2015;46(3):153-156
26 涂响安,吕坤龙,赵亮,等.微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用:附视频.中华腔镜泌尿外科杂志·电子版2014;8(6):59-61
27 Hopps CV,Lemer ML,Schlegel PN,et al.Intraoperative varicocele anatomy:a microscopic study of the inguinal versus subinguinal approach.J Urol 2003;170(6 Pt 1):2366-2370
2 卓晖,魏仁波,李强.显微镜辅助下精索静脉曲张结扎术手术疗效及体会(附32例报告).四川医学2015;36(4):549-550
3 Mohammadi A,Ghasemi-Rad M,Mladkova N,et al.Varicocele and Nutcracker Syndrome:sonographic Findings.Journal of Ultrasound in Medicine 2010;29(8):1153-1160
4 平萍,陈向锋,王鸿翔,等.显微外科技术在男性不育症治疗中的应用及疗效分析.中国计划生育和妇产科2015;7(1):20-22
5 曹志强,王阳.不同手术方式治疗精索静脉曲张的回顾性分析(附658例报告).现代泌尿外科杂志2014;19(10):658-661,677
6 Nikitin OD,Bazalitskaia SV.Efficiency of surgical treatment of varicocele for restoration of reproductive function.Klin Khir 2013;(10):63-66
7 Park YW, Lee JH. Preoperative predictors of varicocelectomy success in the treatment of testicular pain.World J Mens Heahh 2013;31(1):58-63
8 Ding H,Tian J,Du W,et al.Open non-microsurgical,laparoscopic or open microsurgical varicocelectomy for male infertility:a meta-analysis of randomized contro11ed trials.BJU Int 2012;110(10):1536-1542
9 蔡华戈.低位显微外科与腹腔镜精索静脉结扎术治疗精索静脉曲张性不育的临床疗效对比.医药前沿2014;(6):206
10曹礼庭,顾鹏,张敏惠,等.彩色多普勒超声对亚临床型、临床型精索静脉曲张内径及反流检测的临床意义.临床超声医学杂志2003(3):161~163.
11 赵斌,吴荣德,于启海,等.儿童精索静脉曲张患病情况的调查.中华小儿外科医杂志2005;26(3):132-134
12 Dohle GR,Glassberg KI.How common are varicocoeles?New data on the prevalence in adolescence and new discussions.Andrology 2013;1(5):661-662
13 G?k?e A,Davarci M,Yal?inkaya FR,et al.Hereditary Behavior of Varicocele.J Androl 2010;31(3):288-290
14 刘毅东,叶惟靖,吴旻,等.显微镜下精索静脉结扎术治疗青春期精索静脉曲张.临床小儿外科杂志2015;14(1):45-47
15 吴阶平.吴阶平泌尿外科学.济南:山东科学技术出版社,2004:1951
16 邓志海,潘斌,洪余德,等.显微镜手术联合麒麟丸治疗精索静脉曲张致弱精子症.中华实验外科杂志2015;32(6):1454-1455
17 Ozturk MI,Koca O,Keles MO,et al.The impact of unilateral experimental rat varicocele model on testicular histopathology,Leydig cell counts,and intratesticular testosterone levels of both testes.Urol J 2013;10(3):973-980
18朱宏,陈斌,吕逸清,等.手术治疗对精索静脉曲张不育患者精浆瘦素水平及精子凋亡率的影响.中国男科学杂志2013;27(11):19-22,26
19 李海峰,赵洪波,祝海.腹股沟下显微精索静脉结扎术、传统经腹股沟途径与腹腔镜精索静脉结扎术疗效对比研究.中国医刊2013;48(2):67-69
20 Mehta A,Goldstein M.Microsurgical varicocelectomy:a review.Asian J Androl 2013;15:56-60
21 江专新,覃云凌,于建红,等.局麻下显微外科曲张精索静脉结扎术疗效与安全性评价(附62例报道).中国男科学杂志2014;28(12):48-49
22 Cayan S,Shavakhabov S,Kadioglu A.Treatment of palpable varicocele in infertile men:a meta-analysis to define the best technique.J Androl 2009;30(1):33-40
23 Diegidio P,Jhaveri J K,Ghannam S,et al.Review of current varicocelectomy techniques and their outcomes.BJU Int 2011;108(7):1157-1172
24 Goldstein M,Gilbert BR,Dicker AP,et al.Microsurgical inguinal varicocelectomy with delivery of the testis:an artery and lymphatic sparing technique.J Urol 1992;148(6):1808-1811
25 吕坤龙,邬健斌,吴观土,等.腹股沟下显微精索静脉结扎术与腹膜后精索内静脉高位结扎术疗效比较.新医学2015;46(3):153-156
26 涂响安,吕坤龙,赵亮,等.微型血管多普勒在改良腹股沟下显微精索静脉结扎术中的应用:附视频.中华腔镜泌尿外科杂志·电子版2014;8(6):59-61
27 Hopps CV,Lemer ML,Schlegel PN,et al.Intraoperative varicocele anatomy:a microscopic study of the inguinal versus subinguinal approach.J Urol 2003;170(6 Pt 1):2366-2370