spermatic vein ligation

Varicocele is a common disease in men. The incidence of normal general population is about 15%, and the incidence of infertile people is about 35%. Animal experiments and clinical studies have shown that varicocele can cause progressive testicular decline. 75% to 85% of patients with varicocele can cause secondary infertility. The spermatic vein ligation is currently the most common procedure for the treatment of male infertility. The spermatic vein ligation can improve the quality of semen in 60% to 80% of patients, and the postoperative conception rate is 20% to 60%, which can also improve serum testosterone levels in patients with infertility and serum testosterone (Suetal, 1995). Treatment of diseases: varicocele Indication 1) varicocele infertility, there is abnormal semen examination, no other diseases affecting fertility found in medical history and physical examination, endocrine examination is normal, no abnormal findings are found in the fertility test of the woman, regardless of the severity of varicocele, as long as the spermatic cord Once the diagnosis of varicose veins is established, surgery should be performed promptly. 2) Severe varicocele with obvious symptoms, such as scrotal swelling and pain after standing, physical examination found that the testicles are significantly reduced, even if there is already fertility, patients may have treatment wishes can also consider surgery. 3) Clinical observation found that the incidence of prostatitis and seminal vesiculitis in patients with varicocele increased significantly, twice as many as normal people. Therefore, if both diseases are present at the same time, and prostatitis is not cured for a long time, it is also recommended to be a spermatic vein. Varicose surgery. 4) For adolescent varicocele, because it often leads to pathological progressive changes of testis, it is currently advocated that adolescent varicocele with testicular volume reduction should be treated as soon as possible to help prevent adulthood. Education. 5) For patients with mild varicocele, if the semen analysis is normal, regular follow-up should be performed. Once the abnormal semen analysis, testicular shrinkage, and soft texture should be performed, surgery should be performed in time. Contraindications 1) Secondary varicocele. 2) Primary varicocele if the side branch is poorly refluxed, there is collateral regurgitation. Preoperative preparation 1. Semen analysis to see if there is sperm suppression; 2. Straight endocrine and anti-sperm antibodies are checked to see if there are other factors causing semen abnormalities; 3. Clean the skin of the surgical field; 4, the use of spinal anesthesia or epidural anesthesia should be routinely fasted, banned before surgery. Surgical procedure Inguinal approach: 1, supine position, oblique incision above the groin. 2, cut the external oblique muscle membrane, cremaster muscle, open the inguinal canal, free spermatic venous plexus, carefully separate each of the spermatic vein, usually 3 to 4 branches. 3, mention the Qu Zhang De spermatic vein, respectively, double ligation, the middle section to be removed, pay attention to protect the vas deferens, testicular artery and lymphatics. 4. After confirming that there is no venous leakage, the spermatic cord, the cremaster fascia and the external oblique muscle membrane are sutured, the outer ring mouth is reconstructed (only the little finger can be accommodated), and the skin is sutured. Retroperitoneal approach: 1, supine position, the inner ring at the 3 ~ 5cm long incision. 2, incision of the external oblique muscle membrane, blunt separation of the abdominal oblique and abdominal transverse muscle, abdominal transverse fascia. 3, push the peritoneum to the medial side, the spermatic blood vessels are exposed, and when pushing the peritoneum, be careful not to push the spermatic cord together to the inside, causing difficulty in finding the spermatic vein. The large internal spermatic vein is often one, and can also be as many as 3 to 4. 4. Carefully separate each vein, double ligature, and remove the middle section. Take care to protect the spermatic artery and try to avoid damage or being tied. 5, check no vein leakage, stratification close the incision. complication Common complications after spermatic vein ligation include postoperative edema, testicular artery injury, and recurrence of varicocele. 1. Edema: Edema after varicocele ligation is the most common complication, the incidence rate is 3% to 33%, with an average of 7%. Lymphatic injury or ligation is the main cause of edema. 2, testicular artery injury: postoperative testicular atrophy or sperm deficiency, mostly due to ligation or injury to the testicular artery. Animal experiments and studies of humans have shown that testicular artery ligation can cause testicular damage to a large extent, especially in infertile patients. 3, varicocele recurrence: recurrence rate after spermatic vein ligation was 0.6% to 45%. Most common in adolescent patients. Most of them cause recurrence due to technical or anatomical factors, missed or incapable of simultaneously treating the external veins of the internal spermatic vein system. The outer ring approach uses microdissection techniques to treat all veins with a low recurrence rate.