Department of Urology, Emory University, Atlanta, Georgia.
Fertil Steril. 2013 Dec;100(6):e42. doi: 10.1016/j.fertnstert.2013.08.025. Epub 2013 Sep 26.
To demonstrate our approach to the microsurgical subinguinal varicocelectomy with testicular delivery.
An instructional video demonstrating the surgical procedure in a step-by-step manner, highlighting useful surgical techniques.
Not applicable.
PATIENT(S): Patients with male factor infertility.
INTERVENTION(S): After appropriate patient selection and counseling, varicocelectomy is performed with a subinguinal approach utilizing the surgical microscope. The patient is under general anesthesia and we employ an operating microscope. The patient is positioned supine.
MAIN OUTCOME MEASURE(S): Not applicable.
A 2.5-cm subinguinal incision was made and the testicle was then delivered. Through the operating microscope at 10-20X magnification, internal spermatic veins were identified and ligated. Smaller veins were taken with electrocautery. The testicular artery was identified using the microdoppler probe. We employ hydrodissection in identifying and isolating the testicular artery. The spermatic cord is then repeatedly examined until no veins other than deferential veins remain. The gubernaculum is also thinned sufficiently so that veins on both sides can be identified and ligated. Testicular delivery was performed and external spermatic veins as well as gubernacular veins ligated.
CONCLUSION(S): Varicoceles are found in up to 15% of all men, and in up to 40% of infertile men. Varicoceles have negative effects on testicular function. Varicocelectomy improves testicular function and may halt the accelerated rate of decline in testicular function associated with varicoceles. Sperm parameters, serum testosterone levels, and pregnancy rates have all been shown to improve following varicocelectomy. Use of the operating microscope, the microdoppler probe, and black and white sutures aid in efficiency. Testicular delivery is useful to ligate external spermatic veins as well as gubernacular veins.
展示我们经皮精索内静脉结扎术联合睾丸 delivery 的方法。
分步演示手术过程的教学视频，突出有用的手术技巧。
不适用。
男性因素不孕患者。
在适当的患者选择和咨询后，采用经皮精索内静脉结扎术，使用手术显微镜。患者全身麻醉，使用手术显微镜。患者仰卧位。
不适用。
做一个 2.5 厘米的皮下切口，然后将睾丸 delivery。通过手术显微镜 10-20 倍放大，识别并结扎精索内静脉。用电烙术处理较小的静脉。用微多普勒探头识别睾丸动脉。我们采用水分离来识别和分离睾丸动脉。然后反复检查精索，直到只剩下精索内动脉。然后将精索充分变薄，以便可以识别和结扎两侧的静脉。进行睾丸 delivery，并结扎精索外静脉和精索内静脉。
在所有男性中，高达 15%的人患有精索静脉曲张，在高达 40%的不育男性中患有精索静脉曲张。精索静脉曲张对睾丸功能有负面影响。精索静脉曲张结扎术可改善睾丸功能，并可能阻止与精索静脉曲张相关的睾丸功能下降加速。精索静脉曲张结扎术后，精子参数、血清睾酮水平和妊娠率均有所改善。使用手术显微镜、微多普勒探头和黑白缝线有助于提高效率。睾丸 delivery 有助于结扎精索外静脉和精索内静脉。
