Transinguinal spermatic vein ligation

Varicocele refers to the elongation, expansion, and distortion of the variegated venous plexus. The veins from the testis and epididymis form the varicocele plexus, which enters the inguinal canal through the inguinal canal to collect 3 to 4 veins. After the inner ring enters the peritoneum, it merges into 1 or 2 internal spermatic veins. Finally, the right internal spermatic vein slanted into the inferior vena cava, and the left side enters the left renal vein at a right angle. Clinically, left varicocele is the most common. High ligation of the internal spermatic vein is a common surgical method for the treatment of varicocele. It is suitable for patients with good collateral circulation and no collateral venous reflux. There are two kinds of paths for surgery: one is laparoscopic surgery, which has been widely carried out, but special equipment is required. The other is open surgery. Open surgery also has two kinds of paths: one is through the inguinal incision, the internal spermatic vein is ligated at the inner ring; the other is through the axillary approach, the internal spermatic vein is ligated in the high retroperitoneal space. Both have their own advantages and disadvantages: the former has a shallow anatomical level and is easy to reveal, but there are many branches of the spermatic vein, which are easy to be missed or misplaced. The latter has a deeper anatomical level, but the internal spermatic vein is very Less branching, easy to accurately ligature. The indications, contraindications, preoperative preparation, anesthesia, postural position and postoperative treatment of the two were the same. Treatment of diseases: varicocele Indication Intra-abdominal spermatic vein ligation is applicable to: Primary varicocele, with good collateral circulation or no collateral venous reflux. The following conditions are available for indications: 1. Patients with severe symptoms who are not treated by non-surgical treatment. 2. There are testicular spermatogenic dysfunction, accompanied by testicular atrophy, causing infertility. 3. Also accompanied by inguinal hernia or hydrocele. Contraindications Secondary varicocele; primary varicocele, if the collateral circulation is poor, collateral venous reflux is considered taboo. Preoperative preparation 1. Defining varicocele is primary, and the collateral circulation is good. 2. Shave the pubic hair 1d before surgery and clean the vulva. Surgical procedure 1. Incision: taking the inguinal oblique incision 2. Separation of varicose veins: Incision of the skin, subcutaneous tissue and external oblique aponeurosis along the incision, protection of the inferior tibiofibular and iliac sulcus nerves, retracting the intra-abdominal oblique muscles, cutting the cremaster muscle in the direction of the muscle fibers, revealing the essence The varicose veins of the cord. The spermatic fascia is then cut along the direction of the spermatic cord, and the branches of the varicose veins are separated near the inner ring. The invigorating vein and the accompanying spermatic artery and vas deferens should be properly protected, and the varicose veins should be separated into the outer ring direction by 4 to 5 cm. 3. Ligation of the internal cord of the spermatic cord: the inner vein of the spermatic cord is cut in the inner ring clamp, and the proximal end is double-slited, and a long tail is left. Lift the distal end, remove a piece of varicose vein (the length of 3 ~ 4cm), and double ligature the distal end, leaving a long tail. 4. Traction spermatic cord: the two ends of the spermatic vein are overlapped and ligated together to shorten the spermatic cord; then the two ends of the ligature line are put on the round needle, respectively, and the outer edge of the oblique internal muscle is worn out. After ligation, the spermatic cord is pulled upwards. 5. Suture incision: After the wound is completely hemostasis, the cremaster muscle is sutured with a thin wire cross-section to further increase the spermatic cord. Check the wound for bleeding, suture the external oblique muscle aponeurosis with a medium-sized silk thread, the outer ring mouth can accommodate a small fingertip, and finally suture the subcutaneous tissue and skin with a thin wire. complication Postoperative recurrence The main reason is that the preoperative varicocele is primary or secondary, the venous collateral circulation is unclear, and the internal spermatic vein is not ligated at the high position above the inner ring, so that multiple varicose veins Failure to completely ligature caused recurrence. If the symptoms are not heavy after recurrence, non-surgical treatment can be used; if the symptoms are obvious, reoperation can be performed through the retroperitoneal route. 2. Testicular atrophy Misplacement or injury of the internal spermatic artery can lead to a gradual shrinkage of the testis after surgery. If there is no discomfort, it can not be treated, otherwise testicular excision should be performed.