精索静脉曲张 - 诊断与治疗 - 妙佑医疗国际

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精索静脉曲张

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诊断

医生会进行体格检查，可能会在您睾丸上方发现一个感觉像蠕虫袋似的无触痛肿块。如果足够大，医生就能感觉到。如果精索静脉曲张较小，医生可能会要求您站起来，深呼吸，并屏息用力下推（瓦尔萨尔瓦动作）。这有助于医生发现静脉异常扩张。如果体格检查无法确诊，医生可能会要求做阴囊超声波检查。这项检测利用高频声波来创建体内结构的精确图像，以确保您的症状无其他病因。在某些情况下，进一步的影像学检查可以排除精索静脉曲张的其他原因，例如肿瘤压迫精索静脉。

Imaging test

Your health care provider may want you to have an ultrasound exam. Ultrasound uses high-frequency sound waves to create images of structures inside your body. These images may be used to: Confirm the diagnosis or characterize the varicocele Eliminate another condition as a possible cause of signs or symptoms Detect a lesion or other factor obstructing blood flow

Our caring team of Mayo Clinic experts can help you with your 精索静脉曲张-related health concerns

治疗

精索静脉曲张可能不需要治疗。许多患有精索静脉曲张的男性不经任何治疗就具有生育能力。然而，如果精索静脉曲张引起疼痛、睾丸萎缩或不孕不育症，或者您正在考虑辅助生殖技术，则可能需要接受精索静脉曲张修复治疗。手术的目的是封闭受影响的静脉，使血流重新流向正常的静脉。在男性不育症的情况下，精索静脉曲张治疗可能会改善或治愈不孕不育症，或者在使用体外受精（IVF）等技术时提高精子质量。在青春期修复精索静脉曲张的明确适应症包括进行性睾丸萎缩、疼痛或异常精液分析结果。虽然精索静脉曲张治疗通常能改善精子特性，但不清楚未经治疗的精索静脉曲张是否会导致精子质量随着时间的推移而逐渐恶化。精索静脉曲张的修复风险相对较小，可能包括：睾丸周围积液（鞘膜积液）精索静脉曲张复发感染动脉损伤修复方法包括：开放性手术。这种治疗通常在门诊进行，需要使用全身或局部麻醉。通常，外科医生会通过腹股沟（腹股沟或腹股沟下）进入静脉，但也有可能在腹部或腹股沟下方做一个切口。精索静脉曲张修复术的进步已经能够减少术后并发症。一个进步是手术显微镜的使用，让外科医生能够在手术中更好地观察治疗区域。另一个进步是多普勒超声的使用，这有助于引导手术。两天后便可恢复正常的低强度活动。只要没有感觉不舒服，便可在两周后恢复更剧烈的活动，比如锻炼。这种手术引起的疼痛一般比较轻微，但可能持续数天或数周。您的医生可能会在手术后的一段有限时间内给您开止痛药。这之后，您的医生可能会建议您使用非处方止痛药，例如对乙酰氨基酚（Tylenol 等等）或布洛芬（Advil、Motrin IB 等等）以缓解不适感。您的医生可能会建议您在一段时间内不要进行性生活。大多数情况下，需要在术后经过几个月的时间，才能通过精液分析看出精子质量的改善情况。这是因为新精子的发育大约需要三个月。与其他手术方法相比，采用显微镜和腹股沟下入路方式的开放手术（显微外科腹股沟下精索静脉曲张切除术）的成功率最高。腹腔镜手术。您的外科医生会在您的腹部做一个小切口，然后用一个小器械穿过切口来观察和修复精索静脉曲张。这个手术需要进行全身麻醉。经皮栓塞术。放射科医生会在您腹股沟或颈部的静脉中插入一根管子，以便器械从中通过。医生在监视器上观察您扩大的静脉时，会释放弹簧圈或溶液，以形成瘢痕，从而在睾丸静脉中形成阻塞，阻断血流，修复精索静脉曲张的病症。这种手术并未外科手术领域广泛应用。形成栓塞后，您通常可以在两天后返回工作岗位，并在七到十天后开始锻炼。

Surgery

The purpose of surgery is to seal off the affected vein to redirect the blood flow into healthy veins. This is possible because two other artery-and-vein systems supply blood circulation to and from the scrotum. Treatment outcomes may include the following: The affected testicle eventually may return to its expected size. In the case of a teenager, the testicle may "catch up" in development. Sperm counts may improve, and sperm irregularities may be corrected. Surgery may improve fertility or improve semen quality for in vitro fertilization.

Risks of surgery

Varicocele repair presents relatively few risks, which might include: Buildup of fluid around the testicles (hydrocele) Recurrence of varicoceles Infection Damage to an artery Chronic testicular pain Collection of blood around the testicle (hematoma) The balance between the benefits and risks of surgery shifts if the treatment is only for pain management. While varicoceles may cause pain, most do not. A person with a varicocele may have testicular pain, but the pain may be caused by something else - an unknown or not yet identified cause. When varicocele surgery is done primarily to treat pain, there is a risk that the pain may worsen, or the nature of the pain may change.

Surgical procedures

Your surgeon can stop the flow of blood through the testicular vein by stitching or clipping the vein shut (ligation). Two approaches are commonly used today. Both require general anesthesia and are outpatient procedures that usually allow you to go home the same day. The procedures include: Microscopic varicocelectomy. The surgeon makes a tiny incision low in the groin. Using a powerful microscope, the surgeon identifies and ligates several small veins. The procedure usually lasts 2 to 3 hours. Laparoscopic varicocelectomy. The surgeon performs the procedure using a video camera and surgical tools attached to tubes that pass through a few very small incisions in the lower abdomen. Because the network of veins are less complex above the groin, there are fewer veins to ligate. The procedure usually last 30 to 40 minutes.

Recovery

Pain from this surgery generally is mild but might continue for several days or weeks. Your doctor might prescribe pain medication for a limited period after surgery. After that, your doctor might advise you to take nonprescription pain medicine, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) to relieve discomfort. You'll likely be able to return to work about a week after surgery and resume exercise about two weeks after surgery. Ask your surgeon about when you can safely return to daily activities or when you can have sex.

Alternative to surgery Embolization

In this procedure, a vein is blocked by essentially creating a tiny dam. A doctor specializing in imaging (radiologist) inserts a tiny tube into a vein in your groin or neck. A local anesthetic is used at the insertion site, and you may be given a sedative to reduce discomfort and help you relax. Using imaging on a monitor, the tube is guided to the treatment site in the groin. The radiologist releases coils or a solution that causes scarring to create a blockage in the testicular veins. The procedure lasts about an hour. Recovery time is short with only mild pain. You'll likely be able to return to work in 1 to 2 days and resume exercise after about a week. Ask your radiologist when you can resume all activities. 申请 Mayo Clinic 预约

生活方式与家庭疗法

如果您患有精索静脉曲张，导致轻微不适，但不影响您的生育能力，则您可以尝试以下疼痛缓解的方法：服用非处方止痛药，如对乙酰氨基酚（Tylenol 等）或布洛芬（Advil、Motrin IB 等）。佩戴运动支撑物以减轻压力。

准备您的预约

您可能会先就诊初级保健医生。但在某些情况下，当您致电预约时，您可能会立即被转诊至一名泌尿科医生。以下信息可以帮助您做好就诊准备，并了解医生可能会做些什么。来自妙佑医疗国际员工在 Mayo Clinic 治疗申请 Mayo Clinic 预约症状与病因医生与科室 July 02, 2022 打印 Share on: FacebookTwitterWeChat

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CloseWeibo 显示参考文献 Brenner JS, et al. Causes of painless scrotal swelling in children and adolescents. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2017. Varicoceles. American Urological Association Foundation. https://www.urologyhealth.org/urologic-conditions/varicoceles. Accessed Oct. 18, 2017. Ferri FF. Varicocele. In: Ferri's Clinical Advisor 2018. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed Oct. 18, 2017. Eyre RC. Evaluation of nonacute scrotal pathology in adult men. https://www.uptodate.com/contents/search. Accessed Oct. 18, 2017. Wein AJ, et al., eds. Male infertility. In: Campbell-Walsh Urology. 11th ed. Philadelphia, Pa.: Elsevier; 2016. https://www.clinicalkey.com. Accessed Oct. 18, 2017. Johnson D, et al. Treatment of varicoceles: techniques and outcomes. Fertility and Sterility. 2017;108:378. Warner KJ. Allscripts EPSi. Mayo Clinic. Oct. 14, 2019.