摘要目的:观测腹股沟区大隐静脉属支的解剖特征，探讨显微镜下精索静脉结扎联合大隐静脉系-精索静脉超引流技术治疗胡桃夹综合征（NCS）合并精索静脉曲张（VC）的临床疗效。方法:分析2022年2月至2024年2月武汉大学中南医院收治的7例NCS合并VC患者的临床资料，术前通过彩色多普勒超声（CDFI）分析患者左侧大隐静脉属支在腹股沟区的分布、管径、血流情况以及精索静脉曲张的管径和血流情况，术中采用显微镜下左侧精索静脉结扎联合大隐静脉系-精索静脉超引流术进行治疗，术后复查阴囊和肾脏CDFI，比较患者手术前后的临床症状，吻合口通畅情况，精索静脉直径变化及术后复发情况。组间比较采用 t检验。 结果:分析7例患者术前精索静脉及其大隐静脉属支的管径大小及其走行情况：精索静脉直径2.20~3.51 mm，平均直径2.90 mm，血流方向由精索静脉汇流至肾静脉；腹壁浅静脉直径1.71~3.20 mm，平均直径2.32 mm，血流方向由上向下注入大隐静脉；旋髂浅静脉直径1.30~2.23 mm，平均直径1.84 mm，血流方向由外上向内下注入大隐静脉。术前患者左肾静脉直径[腹主动脉前方左肾静脉直径为（1.40±0.29） mm，腹主动脉左侧左肾静脉直径为（9.50±1.78） mm]，术后患者左肾静脉直径[腹主动脉前方左肾静脉直径为（1.30±0.25） mm，腹主动脉左侧左肾静脉直径为（9.20±1.54） mm]，左肾静脉直径术后与术前相比无明显变化，差异无统计学意义（ t＝0.516， P>0.05）；术后患者精索静脉直径[（1.89±0.49） mm]低于术前直径[（2.83±0.64） mm]，差异有统计学意义（ t＝7.573， P<0.05）。7例患者术后阴囊坠胀、阴囊内团块症状均消失，彩超显示精索静脉未见明显迂曲扩张，吻合口血流通畅，7例患者精索静脉曲张术后均无复发。 结论:显微镜下左侧精索静脉结扎联合大隐静脉系-精索静脉超引流术是治疗NCS合并VC的一个安全、有效且可行性较高的新型手术方式。

abstractsObjective:To observe the anatomic characteristics of the branch of the great saphenous vein in the inguinal region, and to investigate the clinical efficacy of microscopically ligation of spermatic vein and bypass surgery of the great sapheno-spermatic vein in the treatment of nutcracker syndrome (NCS) complicated with varicocele (VC) .Methods:Clinical data of 7 patients with NCS complicated with VC admitted to Zhongnan Hospital of Wuhan University from March 2022 to March 2024 were analyzed. The distribution, tube diameter and blood flow of the left saphenous vein branch in the inguinal region as well as the tube diameter and blood flow of varicocele were analyzed by Color Doppler ultrasonography (CDFI) before surgery. Microscopic left spermatic vein ligation combined with great saphenous vein-spermatic vein bypass surgery was performed during the operation. After the operation, Scrotum and kidney CDFI were reviewed, and the clinical symptoms, anastomotic patency, spermatic vein diameter change and postoperative recurrence of the patients were compared. T-test was used for comparison between groups. Results:The preoperative diameter of spermatic vein and its branch of great saphenous vein were analyzed in 7 patients: the diameter of spermatic vein was 2.20-3.51 mm (mean 2.90 mm), the blood flow direction was conjunct from spermatic vein to renal vein. The superficial abdominal vein diameter was 1.71-3.20 mm (mean 2.32 mm), the blood flow direction was injected into the great saphenous vein from the top down. The diameter of the superficial circumflex iliac vein was 1.30-2.23mm (mean 1.84 mm), the blood flow direction was injected into the great saphenous vein from the outside to the inside down. The diameter of the left renal vein of the patient before surgery [the diameter of the left renal vein in front of the abdominal aorta was (1.40±0.29) mm, the diameter of the left renal vein in the left abdominal aorta was (9.50±1.78) mm]. Postoperative left renal vein diameter of patients [the diameter of the left renal vein in front of the abdominal aorta was (1.30±0.25) mm, the diameter of the left renal vein in the left abdominal aorta was (9.20±1.54) mm], there was no significant change in left renal vein diameter after surgery compared with before surgery, the difference was not statistically significant ( t=0.516, P>0.05). The diameter of spermatic cord after operation (1.89±0.49) was significantly narrower than that before operation (2.83±0.64), and the difference was statistically significant ( t=7.573, P<0.05). The symptoms of scrotal distension and mass in the scrotum disappeared in 7 patients after operation. Color ultrasound showed no obvious tortuosity and dilation of spermatic vein, and anastomotic blood flow was unobstructed. There was no recurrence of varicocele in 7 patients after operation. Conclusion:Microscopic left spermatic vein ligation combined with great saphenous vein-spermatic vein bypass surgery is a safe, effective and feasible new surgical method for NCS complicated with VC.