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目的:探讨显微镜下治疗胡桃夹现象合并左侧精索静脉曲张(VC)的临床疗效。方法:回顾性分析2012年8月至2016年2月收治的31例胡桃夹现象合并左侧VC患者的临床资料,根据有无手术治疗及手术方式不同将其分为3组,11例行显微镜下左侧精索静脉结扎术(显微镜结扎组),11例行经腹股沟左侧精索静脉高位结扎术(高位结扎组),9例行保守治疗(保守治疗组)。比较3组患者治疗前和治疗后6个月的精液质量、精索静脉直径变化情况、睾丸体积变化及两组手术组患者的术后复发情况。所有患者随访6~24(15.3±5.4)个月。结果:显微镜结扎组和高位结扎组术后精液质量参数均较术前有明显改善(P<0.05),保守治疗组精液质量参数较前明显下降(P<0.05);显微镜结扎组左侧精索静脉直径及乏氏动作时精索静脉直径术后分别为(1.84±0.22)、(2.16±0.25)mm,高位结扎组分别为(2.15±0.43)、(2.44±0.27)mm,较术前明显变窄(P<0.05),保守治疗组分别为(2.94±0.24)、(3.77±0.26)mm,较前明显变宽(P<0.05)。3组患者左侧睾丸体积治疗后6个月分别为(10.27±1.18)、(9.96±1.72)、(10.48±2.05)ml,与治疗前比较无统计学差异(P>0.05);显微镜结扎组术后复发率与高位结扎组比较无统计学差异(P>0.05)。结论:血尿、蛋白尿等症状较轻的核桃夹现象合并左侧VC的患者可姑息性行精索静脉结扎术,可改善患者临床症状及提高精液质量,显微镜下治疗胡桃夹现象合并左侧VC是一种良好的手术方式。
Objective: To investigate the clinical efficacy of microscopic treatment of Nutcracker combined with left varicocele (VC). Methods: The clinical data of 31 cases of walnut clip combined with left VC in August 2012 to February 2016 were retrospectively analyzed. The patients were divided into 3 groups according to the presence or absence of surgical treatment and surgical methods. 11 cases underwent microscopy Lower left spermatic vein ligation (microscope ligation group), 11 patients underwent inguinal varicocele ligation (high ligation group), 9 patients underwent conservative treatment (conservative treatment group). The changes of semen quality, varicocele diameter, testicular volume change and postoperative recurrence in two groups were compared before treatment and 6 months after treatment. All patients were followed up for 6 to 24 (15.3 ± 5.4) months. Results: The postoperative sperm quality parameters in the ligation group and the ligation group were significantly improved compared with that before operation (P <0.05), while the sperm quality parameters in the conservative treatment group were significantly lower than those before (P <0.05) (1.84 ± 0.22) and (2.16 ± 0.25) mm, respectively, in the ligation group and (2.15 ± 0.43) and (2.44 ± 0.27) mm respectively in the high ligation group compared with those before operation (2.94 ± 0.24) and (3.77 ± 0.26) mm respectively in the conservative treatment group (P <0.05). The left testicular volume of the three groups were (10.27 ± 1.18), (9.96 ± 1.72) and (10.48 ± 2.05) ml respectively at 6 months after treatment, showing no significant difference compared with those before treatment (P> 0.05) There was no significant difference between the postoperative recurrence rate and high ligation group (P> 0.05). Conclusion: Hematuria, proteinuria and other symptoms of mild walnut clip patients with left VC can be palliative varicocelectomy, can improve the clinical symptoms and improve the quality of semen, the treatment of Nutcracker microscope combined with left VC Is a good surgical approach.