Department of Urology, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
Department of Colon, China and Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
Urology. 2014 Jan;83(1):94-9. doi: 10.1016/j.urology.2013.08.050. Epub 2013 Oct 24.
To assess the therapeutic effectiveness of microsurgical spermatic-inferior epigastric vein anastomosis for the treatment of nutcracker syndrome (NCS)-associated varicocele in infertile men.
We prospectively analyzed 5 infertile men with NCS-associated varicocele between April 2010 and January 2012. All patients underwent microsurgical spermatic-inferior epigastric vein anastomosis.
The mean operation time was 85.0 ± 13.2 minutes, and the mean postoperative hospital stay was 6.0 ± 0.7 days. During a 1-year follow-up, hematuria completely resolved in 66.7% of patients (2/3) and flank pain resolved in the single patient affected. The peak velocity (PV) at the aortomesenteric portion of the left renal vein (LRV) significantly decreased after surgery (167.24 ± 41.68 cm/s vs 46.98 ± 4.22 cm/s). The PV ratio between the aortomesenteric and hilar portion of the LRV also significantly decreased (12.28 ± 2.32 preoperatively vs 3.40 ± 0.67 postoperatively). The mean sperm count and motility at 6 months (24.38 × 10(6)/mL ± 1.58 × 10(6)/mL and 53.96% ± 6.28%, respectively) and 12 months (30.02 × 106/mL ± 3.52 × 106/mL and 59.40% ± 8.59%, respectively) postoperatively were significantly higher than their preoperative values (15.8 × 106/mL ± 4.53 × 106/mL and 26.76% ± 8.68%, respectively). Overall, 80% of the spouses of patients (4/5) went on to conceive naturally. The complications observed were scrotal edema in 1 patient (20%) and wound infection in 1 patient (20%).
Microsurgical spermatic-inferior epigastric vein anastomosis is a safe and efficient surgical treatment for infertile men with NCS-associated varicocele.
评估显微精索-腹壁下静脉吻合术治疗胡桃夹综合征（NCS）相关精索静脉曲张导致不育症的疗效。
我们前瞻性分析了 2010 年 4 月至 2012 年 1 月期间的 5 例 NCS 相关精索静脉曲张的不育症患者。所有患者均行显微精索-腹壁下静脉吻合术。
手术时间平均为 85.0±13.2 分钟，术后平均住院时间为 6.0±0.7 天。1 年随访时，66.7%（2/3）的患者血尿完全缓解，1 例单侧腰痛患者腰痛缓解。左肾静脉（LRV）主动脉肠系膜段峰值流速（PV）术后明显下降（167.24±41.68 cm/s 比 46.98±4.22 cm/s）。LRV 主动脉肠系膜段与门脉段的 PV 比值也明显降低（术前 12.28±2.32 比术后 3.40±0.67）。术后 6 个月（24.38×106/mL±1.58×106/mL 和 53.96%±6.28%）和 12 个月（30.02×106/mL±3.52×106/mL 和 59.40%±8.59%）的平均精子数和活力明显高于术前值（15.8×106/mL±4.53×106/mL 和 26.76%±8.68%）。总的来说，5 例患者中有 80%（4/5）的配偶自然受孕。观察到的并发症有 1 例（20%）阴囊水肿和 1 例（20%）伤口感染。
显微精索-腹壁下静脉吻合术治疗 NCS 相关精索静脉曲张导致不育症是一种安全有效的手术方法。
