Analysis and protection strategy of testicular artery based on classification of spermatic vessels in microsurgical varicocelectomy
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摘要: 目的 探讨外环下显微精索静脉结扎术中睾丸动脉的保护策略，减小动脉损伤的风险，提高手术安全性。方法 回顾性分析2013年1月—2022年3月我院收治的显微精索静脉结扎术1357例患者的临床资料，记录患者术中精索内静脉，提睾肌/精索外静脉，睾丸动脉的数量、位置及损伤情况并汇总分析。结果 所有患者均顺利完成手术，单侧手术时间25~80 min，双侧手术时间50~160 min。术中发现睾丸动脉1支554例，2支799例，3支及以上71例。精索内静脉数量5~28支，平均(12.6±6.3)支。将外环下精索内血管分为经典型1065例与非经典型359例。睾丸动脉损伤7例，其中经典型1例，非经典型6例，非经典型患者动脉损伤概率高于经典型(P< 0.05)。结论 在熟练掌握外环下精索脉管系统解剖特点的基础上，合适的手术切口、轻柔的外科操作、保持局部组织湿润、血管活性药物的合理使用以及维持适当的动脉压有助于显露睾丸动脉，精良的显微手术器械、规范的显微外科操作可以有效避免动脉损伤。Abstract: Objective To explore the protection strategy of testicular artery in microsurgical varicocelectomy through a subinguinal approach, to reduce the risk of artery injury and improve the safety of surgery.Methods From January 2013 to March 2022, the clinical data of 1357 patients with varicocele who underwent microsurgical varicocelectomy in our hospital were collected and retrospectively analyzed. The number and location of intraoperative spermatic vein, external spermatic/cremasteric vein and testicular artery were recorded and the injury of testicular artery was analyzed.Results All patients were completed the operation successfully. Operation time of unilateral microsurgical varicocelectomy was 25 to 80 min and operation time of bilateral microsurgical varicocelectomy was 50 to 160 min. There were 554 cases with 1 branch of testicular arteries, 799 cases with 2 branches and 71 cases with 3 or more branches. The number of spermatic veins ranged from 5 to 28, with an average of (12.6±6.3). There were 1065 cases in classic form and 359 cases in atypical form. There were 7 cases of testicular artery injury, including 1 case in classic form and 6 cases in atypical form. The probability of artery injury was higher in atypical form than that in classic form (P< 0.05).Conclusion Based on anatomical structures of spermatic cord in subinguinal approach, appropriate incision, gentle surgical operation, keeping the local tissue moist, using vascular active drugs and maintaining proper pressure may help us to reveal testicular artery. Refined microscopic surgical instruments and standardized microsurgical operation may help us to avoid artery injuries.
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表 1 外环下水平血管数量及分型
例 类型 例数(n=1424) 睾丸动脉损伤 χ2 P 精索内静脉/支 1~8 358 9~16 741 17~24 270 ≥25 55 睾丸动脉/支 0.98 0.32 1 554 4 2 799 3 ≥3 71 0 精索血管分型 13.65 ＜0.05 经典型 1065 1 非经典型 359 6 
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