In the past, because of paying attention to the thickening of tendril plexus and varicose veins, vein ligation was performed in scrotum every year in the early days. It was found that the recurrence rate was very high. Now it is thought that it is caused by the back pressure of venous blood column. According to this theory, high ligation of internal spermatic vein is currently used. Good results have been achieved.
Not all these diseases can be treated by surgery. Young unmarried people, if they have symptoms, can use testicular band to improve scrotum, and the symptoms will disappear. Those who have no symptoms or mild symptoms can only use scrotal sling or wear tight underwear or directly use Tomelin to lift pants from scrotum. After these patients got married, their symptoms disappeared. For patients with severe symptoms, high ligation of internal spermatic vein is feasible. That is, all branches of the internal spermatic vein are ligated at the inner ring (Figure 1). If there are omissions, it will often lead to recurrence. After ligation of internal spermatic vein. Venous blood from testis and epididymis can return to inferior vena cava along the external spermatic vein. Or branch to the femoral vein through the subcutaneous vein below the outer ring (Figure 2). It is suggested that the internal spermatic vein be ligated at the posterior abdominal wall above the inner ring. The reason is that the vein becomes a branch and will not be missed. Disadvantages are deep, poor exposure and large tissue damage. Once infection occurs, the retroperitoneal space has low resistance and is easy to spread. So now it is not a routine surgical method. Only for recurrence. Considering the long-term adhesion of the original incision, this surgical approach is adopted.
It is still necessary to improve scrotum with testicular lifting belt before and after operation to improve the cure rate.
Surgical treatment and preventive care
Surgical treatment: severe varicocele, the sperm count was less than 20 million or testicular atrophy for three consecutive times; If varicose veins can disappear when lying still, high ligation of internal spermatic vein is feasible. The surgical methods are as follows:
1. High ligation of internal spermatic vein through inguinal canal: expose the spermatic cord through the same hernia incision, find out the trunk and branches of the internal spermatic vein, and ligation. This surgical method is simple and common. The dilated external spermatic vein and testicular vein can be ligated simultaneously. If surgical microscope is used during the operation, the effect will be better, the recurrence rate will be lower and the complications will be less.
2. Through iliac fossa: the left lower abdominal oblique incision, push the peritoneum, and find the internal spermatic vein behind the peritoneum and in front of the external iliac artery for ligation. The advantage of this is that if the internal spermatic artery is accidentally injured here, it will not cause testicular atrophy. The disadvantage is that traffic branches cannot be processed at the same time.
3. Recently, a catheter was inserted into the left internal spermatic vein via inferior vena cava and left renal vein, and then 5% sodium morrhuate or gelatin sponge and steel ring were injected to embolize this vein to treat varicocele. The disadvantage is venous deformation, and varicocele is a common disease in young men with collateral circulation. Generally 10% of young men will have varicocele.
The phenomenon, and more than 90% are located in the left. Varicocele is a kind of varicocele caused by various reasons.
Poor reflux leads to the pathological phenomenon of local vein dilatation, circuitous and elongated. Many spermatic veins in clinic
Patients with varicose veins are complicated with oligozoospermia and azoospermia, which affects fertility.
Preventive health care:
1. Pay attention to keep a happy mood, avoid being angry and hurting the liver, pay attention to diet adjustment, and avoid spicy food.
2. Pay attention to the combination of work and rest to prevent strenuous exercise, heavy physical labor and standing for a long time.
3. Restrain sexual intercourse, often wear tight underwear or use scrotum support to prevent scrotum from sagging.
It is not suitable for embolization and needs special equipment.
[Edit this paragraph] About the prevention and nursing of varicocele, choose underwear.
Choose wrapped underwear that can prevent scrotum from falling off and can ventilate and dissipate heat. Some doctors and experts suggest wearing tight underwear or using scrotal support to prevent scrotal sagging.
1) Always wear tight underwear.
At present, the front of all traditional underwear on the market is double-layered, so tightly wrapping a man's baby can easily lead to an increase in the temperature inside, especially in summer, which makes the scrotum wet for a long time and prone to eczema and other skin diseases. Although it prevents the scrotum from descending, it leads to the increase of scrotum temperature, which is even more unfavorable for the prevention and improvement of diseases.
2) Use scrotal support
The scrotum holder can prevent the scrotum from sagging and has the function of ventilation, which is the only inconvenience to wear.
Based on the above two improved methods, the prevention and care of varicocele can not be well satisfied.
At present, among all underwear brands on the market, only pocket underwear patented by king style in Taiwan Province Province can meet the above requirements for prevention and treatment of varicocele. King style patent pocket underwear not only has scrotum pocket design, which can prevent scrotum from sagging and keep it breathable and dry, but also can isolate scrotum from JJ and reduce scrotum pressure. Its unique C and D series design can also position JJ upward, even if it is upright, it can be positioned forward. The three openings keep good ventilation, so it is super convenient to urinate. The fabric is made of American cotton, which has excellent sweat absorption and perspiration effect. It is the best underwear choice for preventing and nursing varicocele.
Rehabilitation and health care of varicocele
1 psychological nursing
It is necessary to master the psychological characteristics of patients, have a heart-to-heart talk with their families, and educate patients about diseases. Friendly interpersonal relationship is extremely important for relieving patients' psychological pressure and anxiety and promoting rehabilitation. With the cooperation of family members, the serious psychological burden and consequences brought by that bad attitude to patients are avoided. The advantages and methods of high ligation of varicocele should be introduced to patients' families before operation, so as to eliminate the tension and fear of patients and their families and make them actively cooperate with the operation. Let patients have full psychological preparation and welcome the operation with a relaxed mood.
2 Preoperative nursing
(1) Under the guidance of medical staff, all examinations and treatments were carried out as planned before operation;
(2) Routine preparation: do a good job in admission education, explain the precautions before and after the operation and the importance of the operation, carry out various biochemical tests, electrocardiogram, chest X-ray, coagulation time check, prepare the skin and clean the vulva;
③ Patient preparation: Do personal hygiene before operation, such as washing hair and taking a bath. Tell patients to rest and prevent colds;
(4) Sign the consent form for the operation.