王艳华 郭树林 吴金华 廖忠祥 刘沛衍

*基金项目：江西省卫生健康委科技计划项目（202311894）

【摘要】 目的：探讨男性少精弱精症型精索静脉曲张（VC）并胡桃夹现象（NCP）行显微镜下精索内静脉-腹壁下静脉逆行转流术（简称“精索静脉转流术”）治疗的效果。方法：选择2021年1月—2023年1月就诊于赣州市人民医院的70例男性少弱精症VC并NCP患者，按随机数字表法分为试验组和对照组，各35例。试验组运用显微镜下精索静脉转流术治疗，对照组运用显微镜下左侧精索静脉高位结扎治疗。对比两组左肾静脉彩超检查结果、精液质量参数、左侧阴囊疼痛情况、左侧VC严重程度。结果：术后，试验组受压段内径D1较对照组高，受压段流速V1慢于对照组，精索静脉曲张内径D3、扩张段内径D2均较对照组低，差异均有统计学意义（P<0.05）。术后，试验组精子密度、向前运动精子百分率均较对照组高，左侧阴囊疼痛评分较对照组低，差异均有统计学意义（P<0.05）。术后，试验组左侧VC严重程度较对照组轻，差异有统计学意义（P<0.05）。结论：显微镜下精索静脉转流术可改善男性少精弱精症型VC并NCP患者左肾静脉内径、血流速度，提高精液质量，减轻左侧阴囊疼痛程度。

【关键词】 男性 胡桃夹现象 少弱精症 精索静脉曲张 精索内静脉-腹壁下静脉逆行转流术 显微镜

Clinical Analysis of the Treatment of Male with Oligoasthenozoospermia Type Varicocele with Nutcracker Phenomenon Through Retrograde Spermatic Vein to Abdominal Wall Vein Shunt under Microscope/WANG Yanhua， GUO Shulin， WU Jinhua， LIAO Zhongxiang， LIU Peiyan. //Medical Innovation of China， 2024， 21（13）： 0-047

[Abstract] Objective： To investigate the therapeutic effect of microscopically guided retrograde spermatic vein to abdominal wall vein shunt （referred to as "spermatic vein shunt"） on male with oligoasthenozoospermia type varicocele （VC） and nutcracker phenomenon （NCP）. Method： A total of 70 male patients with oligoasthenozoospermia， VC， and NCP who visited Ganzhou People's Hospital from January 2021 to January 2023 were selected， and divided into an experimental group and a control group by random number table method， with 35 cases in each group. The experimental group was treated with spermatic vein shunt surgery under a microscope， while the control group was treated with high ligation of the left spermatic vein under a microscope. The results of left renal vein ultrasound examination， semen quality parameters， left scrotal pain， and left VC severity between the two groups were compared. Result： After surgery， the diameter D1 of the compression segment in the experimental group was higher than that in the control group， while the flow velocity V1 of the compression segment was slower than that in the control group， the diameter D3 of the varicocele， and the diameter D2 of the dilated segment were lower than those in the control group， the differences were statistically significant （P<0.05）. After surgery， sperm density and percentage of sperm moving forward in experimental group were higher compared to the control group， while the left scrotal pain score was lower than the control group， the differences were statistically significant （P<0.05）. After surgery， the severity of left VC in the experimental group was milder than that in the control group， the difference was statistically significant （P<0.05）. Conclusion： Microscopic spermatic vein shunt surgery can improve the left renal vein diameter and blood flow velocity， improve semen quality， and alleviate left scrotal pain in male patients with oligoasthenozoospermia type VC and NCP.

[Key words] Male Nutcracker Phenomenon Oligoasthenozoospermia Varicocele Retrograde spermatic vein to abdominal wall vein shunt Microscope

First-author's address： Department of Andrology， Ganzhou People's Hospital， Ganzhou 341000， China

doi：10.3969/j.issn.1674-4985.2024.13.010

胡桃夹综合征（NCP）多见于瘦高人群，以左侧胁腰部酸胀疼痛、蛋白尿、睾丸萎缩、慢性疲劳综合征、血尿等为主要表现，约5.5%患者可继发精索静脉曲张（VC）[1-2]。而VC会直接影响睾丸微循环，睾丸发育及其功能均会受到不良影响，可引起多种严重后果，如精液质量下降、阴囊潮湿、性功能下降等，是男性不育发生的常见因素之一[3-4]。以往临床对于VC并NCP患者多行显微镜下左侧精索静脉高位结扎术治疗，虽能改善患者病情，但精索静脉的代偿作用会丧失，且术中左肾静脉内的高压并不一定降低，甚至可能加重，术后VC易复发[5-6]。……