To retrospectively analyze the surgical procedures for varicocele and their outcomes. METHODS: High Ω ligation of the spermatic vein was used to treat 42 cases of varicocele, and the results were compared with other surgical procedures to compare the clinical effects of the procedure without cutting the spermatic vein. RESULTS: All 42 cases of high Omega ligation of spermatic vein were successful, the operation time of this method was short, the damage was small, no 1 case had complications, and no 1 case of recurrence was followed up from 3 months to 2 years. Conclusion: High Ω ligation of spermatic veins is a desirable method for the treatment of varicocele and is worth promoting.
Varicocele is a common disease in young adults, with a prevalence of 10%-15% in the male population [1], and spermatic vein ligation is the main surgical treatment for it.
1.Data and method
1.1 Clinical data
There were 42 cases in this group, aged 16-51 years old, average 24 years old, all of them had left spermatic varicose veins, including 7 cases with degree 1, 29 cases with degree 2, 6 cases with degree 3, 7 cases with semen abnormalities, all of them had scrotal swelling, swelling and pain, aggravated by prolonged standing, the scrotum could see mass-like varicose seminal veins, and the color ultrasound Valsalva test was positive, all of them except secondary spermatic varicose veins, and different degrees of venous reflux were confirmed [ 1].
1.2 Surgical methods
In this group, local infiltration anesthesia or epidural anesthesia was used, and the incision was chosen to be 2-3 cm on the internal inguinal ring and 3 cm on the medial aspect of the anterior superior iliac spine along the cortex, and 2 cm-4 cm incision was sufficient, and in a few obese patients, the incision could be properly extended outward and upward, and the spermatic vessels could be revealed by cutting the skin, subcutaneous, and extra-abdominal oblique tendon membrane, supporting the internal oblique muscle and transverse abdominal muscle, and pushing the peritoneum inward. This can be confirmed by pulling down on the ipsilateral testis during surgery.
Here the veins in the spermatic cord are mostly confluent to 1~2 branches; with the artery, the varicose vein is directly lifted and separated from the artery about 1~2 cm, and when there are two varicose veins, they can be lifted and separated at the same time to avoid spasm of the vein which is difficult to separate from the artery and mistakenly tie the internal spermatic artery;
Use the meter clamp to pass under the vein and ligate it directly under the meter clamp with No.4 silk, the shape of which is “Ω”, and then remove it in the meter clamp, without cutting the blood vessel and without stopping the bleeding because of the spermatic vein separation, as long as it is within the “Ω” shape ligation. There was no damage to the internal spermatic artery in 42 cases, and the operation was completed by suturing the incision in layers.
2. Efficacy evaluation and results
2.1 Evaluation of efficacy
If the symptoms were reduced, the venous masses were reduced or disappeared, and the semen was abnormal, the semen was improved after 3 months, otherwise it was not effective. Recurrence on the same side after improvement is considered as recurrence.
2.2 Results
The intraoperative operation time of 42 cases in this group ranged from 15 min to 30 min, with an average of 20 min. bleeding was low. The patients were discharged from the hospital on the second day after eating for 8 h after surgery. The group was hospitalized from 3 d to 7 d, with an average of 4 d. The stitches were removed in the outpatient clinic 7 d after surgery, and no complications were observed. All 42 patients felt that their symptoms were reduced or disappeared after surgery, and all 5 cases with semen abnormalities had improvement in semen on re-examination 3 months after surgery. There was no recurrence in 1 case at 3 months to 2 years of follow-up.
3. Discussion
Varicocele is a common urological and male disease, mostly seen in young and middle-aged people, the prevalence rate in male population is 10%-15%, the main symptoms are scrotal swelling, swelling and pain, which can be aggravated by walking or standing for a long time, and venous masses can be palpated in the scrotum, color Doppler
Color Doppler ultrasonography shows intraventricular reflux in the spermatic cord. The disease can affect sperm production and semen quality, accounting for 15% to 20% of the male infertility population, and is considered to be one of the main causes of male infertility. The main cause of its pathogenesis is the reflux of blood from the seminal veins in the spermatic cord caused by various anatomical factors [2]. Therefore, ligation of the internal spermatic veins to block their reflux is the rationale for surgical treatment of this disease and has become the main and effective surgical treatment for this condition.
This procedure has the advantage of removing the varicose seminal vein masses in the scrotum at the same time, but the veins here are trapezoidal and have many branches, which are time-consuming and bleed easily when free, and may damage the arteries and vas deferens, and the veins are easily missed and mistakenly tied to the anastomotic branch vessels, resulting in postoperative ineffectiveness or recurrence.
Another procedure is retroperitoneal spermatic vein high ligation above the internal ring of inguinal canal, which is easier to reveal the free vessels, and generally here the spermatic veins are more confluent into one to two and obviously thickened, and accompany the arteries, and separate from the vas deferens, so it is not easy to damage the arteries and vas deferens, and the ligation is complete, not easy to miss ligation, and not to damage the anastomotic branch vessels, and the operation time is obviously shortened, and the success rate after surgery is obviously improved. At present, this procedure has the tendency to replace the trans-inguinal canal surgery.
Since the 1990s, laparoscopic high ligation of the spermatic vein has been gradually carried out at home and abroad, which has the advantages of good visualization, small trauma, good efficacy and fast recovery. The history of intestinal adhesions or the combination of other abdominal organ lesions can make the operation more difficult. The presence of metallic foreign bodies in the body after surgery may lead to corresponding complications.
From 2005 to 2007, 42 cases of varicocele were treated by high Omega ligation of the spermatic vein in our hospital with good results. The principle of this procedure is the same as that of the above-mentioned retroperitoneal spermatic vein ligation, but with a small incision of 2 cm to 4 cm, the purpose of revealing the free spermatic vessels can be fully achieved, and the effect of spermatic vein “Ω” ligation is the same as that of the traditional ligation method, i.e., there is no need to cut off the vessels and avoid misligation of the internal spermatic artery;
It is also not necessary to stop bleeding because of spermatic vein separation, as long as it is within the scope of “Ω” ligation, it can be completed in one ligation, so it can achieve the effect of short operation time, simple operation, little damage, good curative effect and low recurrence rate; it can also basically meet the cosmetic appearance needs of young patients. At the same time, it does not need general anesthesia, only uses common surgical instruments, the cost is low, does not damage the peritoneum, there is no foreign body left in the body, postoperative complications and other aspects are obviously better than laparoscopic surgery.
The author believes that high Omega ligation of the spermatic vein is an excellent procedure for the treatment of varicocele, with simple operation, high success rate, few complications and low cost, which is worth promoting especially in the majority of primary hospitals.
Objective: To retrospectively analyze the surgical procedures for varicocele and their effects. METHODS: High Ω ligation of the spermatic vein was used to treat 42 cases of varicocele, and the results were compared with other surgical procedures and the clinical effects of the procedure without severing the spermatic vein. RESULTS: All 42 cases of high Omega ligation of the spermatic vein were successful, and this method had a short operation time, little damage, no 1 case of complications, and no 1 case of recurrence at 3 months to 2 years of follow-up. Conclusion: Spermatic vein high Omega ligation is a desirable method for the treatment of varicocele and is worth promoting.