Diagnosis and treatment of subclinical varicocele in infertile men
QIU Jian-guang GAO Xin CAI Yu-bin KE Liang-song
(Department of Urology, the Third Affiliated Hospital of Sun Yat-sen Uinversity of Medical Science, Guangzhou, 510630)
Abstract Purpose: To investigate the diagnosis and treatment of subclinical v aricocele in infertile men. Methods: 32 cases of patients were diagnosed as having subclinical varicocele with Doppler sonography and were treated by 2 mm-diameter needle-shape laparoscopic ligation. Results: The mean operation time of unilateral varicocele ligation was 30 minutes, bilateral 45 minutes; The mean hospitalization time was 1.5days; out of 21 patients who were followed up one year after operation, 16 patients′ wives were pregnant. Conclusions: Subclinical varicocele in infe rtile men could be correctly diagnosed with Doppler sonography; 2 mm-diameter needle shape laparoscopic varicocele ligation was an effective treatment procedure for those patients.
Key words Varicocele Infertility Doppler sonography Needle shape laparoscopy
精索静脉曲张是引起男性不育的常见原因，其中一部分患者表现为亚临床型精索静脉曲张。我院从1997年6月～1999年10月利用彩色多普勒检查收治亚临床型精索静脉曲张患者32例，均行针形腹腔镜（2 mm Stryker腹腔镜及器械）左侧或双侧精索静脉高位结扎术，疗效满意，现报告如下。
1 资料与方法
1.1 一般资料
本组32例，年龄22～41岁，平均(32.3±8.8)岁。婚后不育史1～11年，平均(6.0±4.7)年。32例患者均无腰骶部不适和阴囊坠痛，检查睾丸、附睾无异常，阴囊内末扪及曲张的精索血管，精液常规分析、生殖激素6项和血抗精子抗体检查均在正常范围。所有患者均通过彩色多普勒检查获得确诊，21例为左侧精索静脉曲张，11例为双侧精索静脉曲张。
1.2 治疗方法
在连续硬膜外麻醉下行2 mm针形电视腹腔镜左侧或双侧精索静脉高位结扎术。制造1.60～2.00 kPa人工气腹后，不拔除脐窝内气腹针，而在气腹针旁另作一小口，插入2 mm Trocar套管针并放入2 mm针形腹腔镜(Stryker公司产)，直视下在脐下2横指水平左右腹直肌外缘交点分别置入2 mm Trocar套管针，放入2 mm腹腔镜手术器械，在距内环口外2 cm处剪开后腹膜，游离盆腔段精索血管，保护或不保护睾丸动脉，用4号丝线双重结扎血管束。