精索内静脉-大隐静脉分流术治疗胡桃夹综合征继发左侧精索静脉曲张：8例初步探索

Left spermatic vein transposition to great saphenous vein: preliminary experience of a novel bypass procedure in 8 patients in the treatment of left varicocele secondary to nutcracker syndrome

摘要

目的 评估在腹股沟皮下环行左侧精索静脉-大隐静脉的分流手术治疗胡桃夹综合征（NCS）继发左侧精索静脉曲张（VC）的疗效。方法 报告并分析2020年2月-2023年2月于联勤保障部队第940医院泌尿外科确诊的NCS继发左侧VC的8例患者的资料，通过术前彩超详细评估精索静脉和大隐静脉的血管状况，对经过严格筛选的患者实施精索静脉-大隐静脉分流术，比较患者术前术后临床症状以及肾静脉血流动力学变化。结果 患者中位年龄23.5（18～33）岁。术后所有患者运动后阴囊疼痛以及腰背部疼痛评分明显下降，其中7例患者阴囊疼痛评分降为0分。运动后尿蛋白定量术前为352.8（54.4～687.3）mg，术后6个月随访尿蛋白定量为125.5（25.9～255.1）mg。术前3例尿潜血阳性患者，术后随访均未检出尿潜血。左肾静脉狭窄处术前血流峰值（PV₂）74.4（48.7～117.6）cm/s，下降至术后45.1（25.5～61.2）cm/s。6个月随访期内，8例患者VC均未复发。术后复查吻合口血流通畅，未见血管吻合口闭锁或血栓形成。结论 对于NCS继发VC的患者，可根据血管直径制定个体化的治疗方案。在经严格筛选的患者群体中，精索静脉-大隐静脉分流术在治疗NCS继发VC方面安全可行，能够有效减轻肾静脉淤血症状且没有明显并发症。

Abstract

Objective To evaluate the efficacy of the left spermatic vein transposition to the great saphenous vein in treating left varicocele (VC) secondary to nutcracker syndrome (NCS). Methods Clinical data of 8 patients treated during Feb. 2020 and Feb. 2023 in our hospital were retrospectively analyzed. A meticulous preoperative evaluation of the vascular status of the spermatic vein and the great saphenous vein was performed using color Doppler ultrasound. A spermatic vein-great saphenous vein shunt surgery was performed in patients who were strictly selected. The clinical symptoms and hemodynamics of renal vein were compared before and after operation. Results The median age of patients was 23.5 (18-33) years. There was a notable reduction in post-exercise scrotal and lower back pain in all patients, and the score of scrotal pain decreased to 0 in 7 patients. The median quantification of urinary protein was 352.8 (54.4-687.3) mg prior to surgical intervention, which significantly diminished to 125.5 (25.9-255.1) mg 6 months after operation. Notably, 3 cases of preoperative positive urine occult blood tests were undetectable in the subsequent postoperative assessments. The median peak blood flow velocity at the site of stenosis in the left renal vein measured at 74.4 (48.7-117.6) cm/s preoperatively, subsequently reduced to 45.1 (25.5-61.2) cm/s postoperatively. During the 6-month follow-up, no recurrence of varicocele, vascular anastomotic stenosis or thrombosis were observed. Conclusion Our research indicates that spermatic vein to great saphenous vein bypass is safe and feasible in the treatment of left varicocele secondary to nutcracker syndrome for strictly selected patients, which can effectively alleviate renal vein congestion without significant complications.

关键词

胡桃夹综合征 / 分流术 / 精索静脉曲张 / 大隐静脉

Key words

nutcracker syndrome / bypass / varicocele / great saphenous vein

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基金资助

兰州市青年科技人才创新项目(2024-QN-127)

军队计生专项科研课题项目(21JSZ13)