spermatic lymphatic-vein anastomosis

The spermatic lymphatic-venous anastomosis is a lymphatic drainage procedure. The theoretical basis is that patients with chyluria have obstruction of the lymphatic system along the thoracic duct or the para-aortic, so the pressure in the lymphatic vessels below the obstruction site increases, and the lymphatic vessels expand and communicate with each other. The spermatic lymphatic-venous anastomosis allows the chylolysis fluid in the lymphatic vessels of the high-pressure lymphatics to flow into the spermatic vein through the spermatic lymphatic vessels, reducing the deposition of the retroperitoneal lymph, so that the lymphatic pressure of the kidney or ureter is reduced, and the lymphatic tissue is promoted. When the sputum is closed, the chyluria disappears. This procedure has the advantage of being simple and painful. However, in recent years, studies on the pathogenesis of chyluria have shown that chyluria is caused by changes in lymphatic dynamics rather than lymphatic obstruction. It seems that the lymphatic-venous shunt does not fit the lymphatic dynamics theory of chyluria. However, the clinical effect is quite satisfactory. Curing disease: Indication The spermatic lymphatic-venous anastomosis is suitable for male patients with longer course and repeated chyluria. This type of patient has obvious lymphatic vessel dilatation and better surgical results. Contraindications This procedure should not be used for diseases where spermatic inflammation and spermatic venous return are blocked. Preoperative preparation 1. Pathogen treatment, taking 1 to 2 courses of anti-filaria drugs. 2. Improve the general condition and strengthen supportive care. 3. Pay attention to the cleaning of the surgical area. Surgical procedure Anesthesia and position Anesthesia with spinal anesthesia or epidural anesthesia can also be used for local anesthesia. Supine position. Surgical procedure Incision Incision is made in the inguinal canal area from the inner ring to the outer ring. Because the left and right lymphatic vessels communicate with each other at the level of the iliac vessels, any groin incision can be selected. However, it is best to choose the same side of the chyluria, which can shorten the lymphatic decompression pathway. 2. Reveal Cut the skin, subcutaneous tissue, and external oblique aponeurosis, reveal the spermatic cord, and release the spermatic cord. 3. Lymphatic staining In the testis or in the lower part of the spermatic cord, 0.5 to 1.5 ml of methylene blue and 1% procaine mixture was injected. After 2 to 3 minutes, the spermatic lymphatics were stained blue. Generally, there are 4 to 8 lymphatic vessels in each side of the spermatic cord, and 2 to 3 large lymphatic vessels are often seen in patients with chyluria. 4. Free lymphatic vessels and veins Under the operating microscope, two thick lymphatic vessels were used to separate two thick lymphatic vessels 1 to 2 cm and two spermatic veins of the same diameter. 5. spermatic lymphatic-venous anastomosis Two free spermatic lymphatic vessels and veins were clipped with a vascular clamp, and the distal end was ligated with a silk thread. The centripetal end was flushed with heparin isotonic saline, and the spermatic lymphatics were anastomosed with the vein. If the spermatic lymphatic vessel is too far apart from the venous diameter, it should be used for end-to-side anastomosis. The anastomosis line uses a 9-0 to 11-0 non-invasive suture, first through the vein wall, and then through the lymphatic wall. The first needle is sutured to the posterior wall, the second needle is anastomosed to the anterior wall, and the two wires are gently pulled. One stitch is applied to each of the left and right walls. After the anastomosis, the blood vessel clamp is loosened to check whether there is oozing or blood leakage, and whether the proximal vein is filled or not. Feeling or creeping. 6. Suture incision After the anastomosis is completed, the spermatic cord is returned to the original position, and then the surgical incision is sutured according to the incision level

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