摘要
本文报告一例精索静脉曲张手术疑似失败病例的处理经过。患者双侧精索静脉曲张（左侧Ⅲ度，右侧Ⅱ度）伴局部疼痛不适及精液质量严重异常，行腹腔镜双侧精索静脉高位结扎术，术后2个月自觉局部坠胀、疼痛症状明显缓解，但双侧阴囊的迂曲较术前更加明显，疑似手术失败并再次人院。经临床和实验室检查后，发现患者无明确手术失败证据，选择对症治疗而避免再次手术。观察等待3个月后复诊，患者临床表现（鞘膜积液及坠胀感）减轻，实验室检查精液质量改善，超声检查乏氏动作后双侧精索静脉未见返流，双侧睾丸鞘膜未见明显积液，进一步确诊术后症状为术后暂时性侧枝循环建立不佳所致，而这种情况在同类手术中比较常见。综合本病例及文献报道，我们建议要严格掌握再手术的指证：明确的复发征象（与体位相关的精索静脉曲张及血液返流）；患者的原始诉求（疼痛不适、精液质量异常）仍然存在且无改善。难以判断者，建议观察等待，以避免不必要的再次手术。通常术后应观察3～6个月再进行综合判定。
This article reported the management of one patient with suspected failure of varicocelectomy. The patient suffered from bilateral varicocele of III degree in left side and II degree in right side,aggravated bearing-down pain in the left scrotum and severe deterioration of semen quality. He accepted bilateral varicocelectomy under peritoneoscope. Two month after operation,he felt that scrotum dropping feeling and pain were relieved significantly but tortuous of bilateral scrotum was more serious. The patient was administrated again due to suspicion of operation failure. Systematic clinical and experimental detections found no evidence for recurrence of varicocele. The reoperation was not considered and the observation and symptomatic treatment were performed. Three month later, clinical symptoms including hydrocele of tunica vaginalis, local pain and discomfort were diminished and semen quality was improved. The blood backflow in bilateral varicocele after Valsalva exercise and hydrocele of tunica vaginalis in both testes were not found by ultrasound detection. All of the evidence indicated that the post- operative transient symptoms were due to imperfective circulation of lateral branch which were quite common in such kind of operation. In summary, after reviewing the case and relative literatures, we suggested that indications for reoperation of varicocele should be strictly cautious, unless there are the evidences of the recurrence of varicocele or original complains are not improved. The observation and symptomatic treatment are only suggested for the patients with difficult to judge in order to avoid unnecessary reoperation. The best choice is to make a comprehensive judgment three to six months follow up after operation.
出处
《生殖医学杂志》
CAS
2015年第2期134-137,共4页
Journal of Reproductive Medicine
