Objective Although microsurgical varicocelectomy shows obvious advantages in lower recurrence and complication for varicocele patients, it is still full of challenges for surgeons to select the suitable patients and deal with the special circumstances, such as confusing of artery and veins, anatomical variation, etc. In this study, we summarized and reported our experiences on the treatment of special circumstances for microsurgical varicocelectomy. Methods We retrospectively analyzed clinical data of all varicocele patients from September, 2010 to June, 2015, and summarized some experiences on microsurgical varicocelectomy, including surgical selection on the patients of adolescence and subclinical stage, operation through above scrotum cut, dissection on reticular and pampiniformis venous plexus, discrimination of artery and veins, blur of visual field after small vessels damaging, discrimination of small lymphatic vessel and venous, geneogenous and postsurgeric anatomical variation in operative region in all patients. Results Total of 357 varicocele patients underwent microsurgical varicocelectomy during five years. We summarized some surgical skills targeting on special circumstances in microsurgical varicocelectomy, for example, pimobendane using for discrimination of artery and veins, different treatments for small vessels damaging, microprocessing on artery encysted by pampiniformis venous plexus, and processed experience as surgical complications as postsurgical scrotal swelling and pain. Conclusion Microsurgical varicocelectomy is a favorable selection for treatment of varicocele patients. Sufficient preoperative communication, refined intraoperative manipulation and hardheadedly handling with emergency situation are the key points for improving prognosis of patients.%目的 本研究拟分析、总结我们开展显微镜下精索静脉结扎术5年来对术前患者的选择以及术中诸如动静脉难以分辨、解剖变异等特殊情况的处理经验.方法 回顾2010年9月至2015年6月开展的显微镜下精索静脉结扎术的病例资料,分析青少年期患者的手术选择,并分析手术期间遇到部分诸如经低位(阴囊上方切口)手术、网状或蔓状静脉丛分离困难、动静脉镜下难以分辨、动静脉破损出血视野模糊、纤细血管及淋巴管难以分辨和手术区域解剖变异(先天性或既往手术后导致的)等较特殊的病例.结果 5年间共357例精索静脉曲张患者接受了显微镜下精索静脉结扎术,经总结出针对上述特殊的病例诸如使用扩张血管药物促进分辨、不同方法处理动静脉破损、仔细处理蔓状静脉丛包绕的动脉等手术技巧以及术后阴囊肿胀、疼痛的等并发症的处理经验.结论 显微镜下精索静脉结扎术是治疗精索静脉曲张患者的良好选择,术前的充分告知和术中的精细操作、冷静处理突发情况是决定手术预后的关键.
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