目的 探讨腹腔镜超声下精索静脉高位结扎术效果。方法 回顾性分析武警山东总队医院2018-10至2020-10收治的32例双侧精索静脉曲张的患者术前、术后临床资料,年龄19～36岁,平均(29.2±2.2)岁,双侧曲张程度均为Ⅱ～Ⅲ度,B超探及曲张静脉直径2.2～4.6 cm,其中至少一侧曲张静脉直径＞3.0 cm 23例。合并少弱精患者13例,术前彩超均排除继发性精索静脉曲张可能。行腹腔镜双侧精索静脉高位结扎术,术中配合腹腔镜超声探查,保留动脉后行高选择性精索内静脉结扎术。记录所有患者手术相关指标、精子相关指标、临床症状缓解率、术后并发症发生情况。结果 本组32例均顺利完成手术,术中均无严重出血及周围脏器损伤,31例术中完整保留双侧精索内动脉,1例术中分离一侧动脉时出现出血,遂行集束结扎,仅保留另一侧动脉。手术时间为(72.53±5.07)min;住院时间为(4.06±0.68)d。患者均于术后6个月门诊随访,阴囊胀痛均有不同程度缓解,均无复发,均未发现睾丸萎缩。13例少弱精患者术前精子密度(14.38±1.26)×10⁶/ml,(a+b)级精子百分比(21.34±2.12)%。术后6个月,均复查精液常规,精子密度(26.15±2.45)×10⁶/ml,(a+b)级精子百分比(35.17±3.87)%。术后精子密度以及(a+b)级精子百分比均较术前显著提高(P＜0.001)。结论 腹腔镜精索静脉高位结扎术配合腹腔镜超声,治疗双侧精索静脉曲张,可有效识别并保留精索内动脉,行高选择性精索内静脉结扎术,术后症状及精液质量改善效果明显。

Objective To investigate the applicability of laparoscopic ultrasound technology in laparoscopic high ligation of the spermatic vein. Methods The preoperative and postoperative clinical data on 32 patients with bilateral varicoceles treated between October 2018 and October 2020 was analyzed retrospectively. These patients were aged 19 to 36, with an average age of (29.2±2.2) years old. The degree of varicoceles on both sides was Ⅱ～Ⅲ. B-ultrasound showed that the diameter of the varicoceles ranged from 2.2 to 4.6 cm. In twenty-three of these cases, the diameter of at least one varicocele was >3.0 cm. Complications with oligospermia were observed in thirteen of these cases. Preoperative examinations with color Doppler ultrasound ruled out the possibility of secondary varicoceles. Laparoscopic high ligation of both sides of the varicoceles was performed. Combined with laparoscopic ultrasound, a highly selective internal spermatic vein ligation was performed after the artery was preserved. Indicators related to the surgery and sperms, the relief rate of clinical symptoms, and postoperative complications were recorded. Results The surgery was a success for all the 32 patients without any severe bleeding or damage to the surrounding organs. The internal spermatic arteries on both sides were completely preserved in all these cases. In one case, bleeding occurred when one artery was separated, so cluster ligation was performed, leaving the patient with only one spermatic artery. The duration of surgery was (72.53±5.07) minutes while the hospital stay was (4.06±0.68) days. The patients were followed up for 6 months. The scrotal pain was relieved to different extents, and there was no recurrence or testicular atrophy. The preoperative sperm density of 13 patients with oligospermia was (14.38±1.26)×10⁶/ml, and the percentage of (a+b) grade sperms was (21.34±2.12)%, compared with (26.15±2.45)×10⁶/ml and (35.17±3.87)% six months after operation. Conclusions Laparoscopic high ligation of the spermatic vein combined with laparoscopic ultrasound in the treatment of bilateral varicoceles can effectively identify and preserve the internal spermatic arteries. Highly selective internal spermatic vein ligation can improve postoperative symptoms and semen quality.