精索静脉高位结扎术与分流术的疗效比较

治疗精索静脉曲张的手术方式有两类，即精索静脉高位结扎木和高位结扎加分流术。我院自1985年以来收治精索静脉曲张65例，其中35例采用精索内静脉高位结扎术，30例采用结扎加分流术，现根据临床结果，将两种术式的临床疗效对比分析如下。1资料与方法1.1一般资料本组65例，年龄19～46岁，平均325岁。左侧精索静脉曲张61例，双侧精索静脉曲张4例；中度（Ⅱ度）精索静脉曲张47例，重度（Ⅲ度）精索静脉曲张18例。病程4个月～8年。因不育就诊28例，精索静脉高位结扎术后复发4例。1.2手术方式35例采用腹股构管内精索内静脉高位结扎术，30例采用腹…     

左精索内-腹壁下静脉分流术治疗胡桃夹征并精索静脉曲张

目的总结采用精索内静脉高位结扎＋左精索-腹壁下静脉分流术治疗胡桃夹合并重度精索静脉曲张的疗效及可行性。方法选取2007年7月至2011年6月收治胡桃夹征并重度精索静脉曲张患者5例,术前采用经彩色多普勒超声及CT/MRI确诊,采用精索内静脉高位结扎＋左精索内静脉-腹壁下静脉分流术治疗,术后复查CDFI、尿常规及精液常规。结果 5例患者手术均获得成功,术后精索静脉曲张消失,未出现血管闭塞、血栓形成及泌尿系并发症。结论精索内静脉高位结扎＋左精索内静脉-腹壁下静脉分流术治疗胡桃夹合并重度精索静脉曲张手术简单,效果肯定。但长期疗效有待观察。     

同轴插管经皮远端硬化栓塞治疗精索静脉曲张

为了减少精索静脉曲张经皮硬化栓塞术中的复发因素，提高硬化剂治疗的效果，从１９９１年３月至１９９５年６月使用同轴插管方法，进行精索静脉远端主干和近端侧支血管的硬化栓塞，共治疗左侧精索静脉曲张２３例，精索静脉近端插管全部成功，远端插管的成功率为７８．０％，栓塞后的显效率为９５．６％，无并发症。平均随访１４个月未见复发。认为该方法可准确、安全、高效地进行精索静脉曲张的硬化治疗。     

腹腔镜下精索内静脉高位结扎治疗精索静脉曲张20例报告

目的：探讨腹腔镜精索内静脉结扎治疗精索精脉曲张的临床价值。方法：腹腔镜下行保留精索动脉的精索内静脉高位结扎治疗精索静脉曲张20例。结果：全部获成功，手术时间平均45min，术后平均住院3天，随访3月--24月，平均7月，无复发，无睾丸萎缩。结论：该方法操作简便，创伤小，恢复快，安全可靠，是治疗精索静脉曲张的有效方法。     

精索静脉曲张手术结扎与血管栓塞治疗男性不育的疗效分析

本文为了对比精索静脉曲张手术结扎与血管栓塞器治疗男性不育的疗效。随机将４６例患者分成手术结扎组和血管栓塞组行对照分析。手术组２５例，血管栓塞组２１例，随访６个月至１年半。结果表明：两组病例的精子数目和精子活动率均有明显增加，而精子形态依然无变化，两种疗法比较无显著性差异（Ｐ〉０．０５）。但海螺状或螺旋球形血管栓塞器（ＮＴ－海球栓）栓塞治疗的优点为缩短住院的时间，可在门诊进行，是目前治疗精索静脉曲张     

青春前期左精索静脉曲张26例治疗体会

目的 探讨青春前期精索静脉曲张安全、有效的治疗方法。方法 采用局麻或腰麻下行左精索静脉腹膜外高位结扎。结果 平均手术时间15min，术后左精索静脉曲张症状消失，术后随访最长10年，左睾丸发育大小、硬度均正常。结论 青春前期左精索静脉曲张行左精索静脉腹膜外高位结扎，术后效果良好，对患侧睾丸发育无影响。     

对比Palomo手术与腹膜后精索内静脉高位结扎术治疗精索静脉曲张

目的对比经腹膜后集束结扎精索血管（Palomo手术）与腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的疗效及并发症。方法对2000年7月-2006年6月间，25例采用Palomo术式，30例采用腹膜后单纯精索内静脉高位结扎治疗精索静脉曲张的临床资料进行对比分析。结果所有手术均获得成功，术后随访6月至2年。Palomo手术组手术时间12～18min，手术后3—10d曲张静脉团显著缩小，所有患者临床症状消失。随访18例，无复发，无睾丸坏死或萎缩发生，6个月内发生左侧睾丸鞘膜积液3例，占16．6％，左侧慢性附睾炎1例，左侧睾丸疼痛（排除其它原因）1例。单纯精索内静脉高位结扎组手术时间20-35min，1例术后无效，29例术后1—8d曲张静脉团消失。3例术后2—4月后复发，占15％。精索内静脉高位结扎组术后复发率显著高于Palomo手术组（P〈O．05），而后者术后并发症明显高于前者，两者有显著的统计学差异（P〈0．05），主要并发症是患侧的睾丸鞘膜积液。后者手术时间明显较短（P〈0．01）。两组手术均效果良好，疗效可靠。结论Palomo手术简单易行、疗效可靠，但并发症较多；腹膜后精索内静脉高位结扎复发率高，但无并发症发生。     

精索静脉高位结扎加转流术治疗精索静脉曲张5例

精索静脉高位结扎加转流术治疗精索静脉曲张５例邵向阳，徐勇我院自１９８２年１０月～１９９４年１２月采用静索静脉高位结扎加转流术治疗精索静脉曲张５例，术后随访无复发，效果满意，报告如下。１临床资料本组５例，年龄２１～３９岁，病程１月～１０年。均为左侧精索...     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张26例报告

目的：探讨腹腔镜精索静脉高位结扎治疗精索静脉曲张的临床价值,总结保留睾丸动脉的单纯精索内静脉高位结扎术及睾丸动静脉集柬高位结扎术的优缺点。方法：回顾分析腹腔镜精索静脉高位结扎术治疗精索静脉曲张26例患者的临床资料,其中14例行保留睾丸动脉的单纯精索内静脉高位结扎术,12例行睾丸动静脉集柬高位结扎术。结果：26例手术均获成功。6例术前诊断为左侧精索静脉曲张的病例术中确诊为双侧精索静脉曲张。睾丸动静脉集柬高位结扎术中1例并发附睾炎。以不育就诊的14例中,保留睾丸动脉的单纯精索内静脉结扎的8例中4例生育,而睾丸动静脉集柬高位结扎的6例中只有1例生育,全部病例未见复发。结论：腹腔镜下精索内静脉高位结扎术具有损伤小,视野清楚,操作简单,并发症少,术后恢复快等优点,尤其适合双侧精索静脉曲张者,可同时探查和治疗双侧精索静脉曲张。保留睾丸动脉的单纯精索内静脉高位结扎术能提高不育症的疗效,减少鞘膜积液的发生率。     

形状记忆血管栓塞器栓塞治疗精索静脉曲张八例报告

形状记忆血管栓塞器栓塞治疗精索静脉曲张八例报告许承斌，陈玉石，胡奇，万向荣，马广勤我院自１９９０年１月始应用海螺状或螺旋球形记忆血管栓塞器（ＮＴ－海球栓）栓塞治疗精索静脉（ＳＶ）曲张８例，收到良好效果，报告如下。一般资料　８例病人均为左侧精索静脉曲张...     

腹腔镜下精索静脉高位结扎术治疗精索静脉曲张(附32例报告)

目的:评价腹腔镜下精索静脉高位结扎术的有效性、安全性及其价值。方法:回顾分析32例腹腔镜下精索静脉高位结扎术的疗效和康复情况。结果:32例手术均获成功,平均手术时间34m in,基本无出血,术后平均住院2.8d,随访3~10个月,2例复发,复发率为6.25%。结论:腹腔镜下精索静脉高位结扎术具有创伤小、恢复快、效果好、并发症少等优点,对双侧精索静脉曲张及预防术后复发更具价值。     

显微外科手术治疗再发性精索静脉曲张——附30例报告

目的 :采用显微外科手术治疗再发性精索静脉曲张症。　方法和结果 :对 30例再发性精索静脉曲张病人用 4倍手术放大镜手术 ,30例均成功 ,未见再次复发。　结论 :对传统各种手术进行讨论 ,并提出应采用显微外科手术治疗传统手术后再发性精索静脉曲张症 ,效果良好。     

Is selective internal spermatic venography necessary in detecting recurrent varicocele after surgical repair?

OBJECTIVES: Surgical varicocele repair can be complicated by postoperative recurrence. The aim of this study is to evaluate the diagnostic value of scrotal color Doppler ultrasonography (SCDU) and selective internal spermatic venography (SISV) in detecting recurrent venous reflux after conventional varicocelectomy. MATERIALS AND METHODS: A total of 36 men (mean age 30.1 +/- 4.3 years) with a persisting left unilateral varicocele and abnormal semen parameters more than 12 months after conventional varicocele repair were evaluated with physical examination, semen analyses, SCDU and SISV. RESULTS: The median interval between primary varicocelectomy and presentation was 13 (range 12-16) months. Physical examination at that time revealed a grade- I left varicocele in 22 and a grade-II left varicocele in 14 patients. Semen analyses showed oligoasthenozoospermia in 30 patients (83%), asthenozoospermia in 4 (11%) and oligozoospermia in 2 (6%). Although all patients had reflux on SCDU, SISV confirmed reflux in 8 (22%) cases. SISV was not able to document recurrence in 28 cases (78%) that were detected by SCDU. CONCLUSIONS: Considering clinical findings, confirmed with SCDU, and semen parameters as the reference point in the diagnosis of recurrent varicocele, the sensitivity of SISV in the radiological documentation of recurrence was 22%. SISV was unable to document the recurrence in 78% of cases implying that reflux was not through internal spermatic veins. Thus, we conclude that SISV is neither necessary nor sufficient in the evaluation of recurrent varicocele.     

Challenging the role of cremasteric reflux in the pathogenesis of varicocele using a new venographic approach

PURPOSE: Cremasteric or extrafunicular reflux is considered by many a major cause of primary and recurrent varicocele. Therefore, surgical techniques that allow ligation of the intrafunicular and extrafunicular veins are often performed. We evaluated the incidence of cremasteric reflux in patients with primary or recurrent varicocele with a new and simple venographic technique. MATERIALS AND METHODS: A series of 73 patients with primary (54) or recurrent (19) varicocele underwent venography of the left iliac vein while standing and performing Valsalva's maneuver to reveal the possible presence of reflux in cremasteric or other extrafunicular veins. In patients with recurrent varicocele antegrade transcrotal spermatic venography was also performed immediately before surgery. RESULTS: None of the patients presented with reflux of contrast material from the left iliac vein to the left pampiniform plexus via the extrafunicular veins. Cremasteric veins, in particular, were always continent at the confluence with the epigastric vein even when grossly dilated at spermatic antegrade venography in recurrent cases. CONCLUSIONS: Cremasteric reflux seems to have a limited role if any in the pathogenesis of primary and even recurrent varicocele. Dilatation of the extrafunicular veins is not necessarily a sign of reflux but may represent only a consequence of venous overflow due to insufficiency of the internal spermatic vein and possibly partial obstruction of the left iliac vein. The rationale of surgical treatments aimed at ligation of the extrafunicular veins should be questioned.     

Adolescent varicocele: treatment by antegrade sclerotherapy

BACKGROUND/PURPOSE:The most effective treatment for adolescent varicocele is still debated, although the same treatment methods used for adults have also been used in children. Since 1991 at the Pediatric Surgery Operative Unit of "S. Camillo" Hospital in Rome a multidisciplinary protocol has been established according to which percutaneous retrograde scleroembolization was suggested as the first therapeutic option. Surgery (retroperitoneal ligation) was reserved for select cases. The author now presents his personal experience with alternative-approach antegrade sclerotherapy. METHODS: Since February 1998, as an alternative to percutaneous retrograde sclerosis and surgical ligation, antegrade sclerotherapy has been performed in 92 varicocele patients, 65 of whom were 11 to 19 years of age. In this group, the indication for treatment was grade III varicocele with spontaneous continual reflux, which worsened with the Valsalva maneuver. Twenty patients had recurrent varicocele after other treatments. RESULTS: At a mean follow-up of 9 months, the clinical recovery rate was 92.6%. CONCLUSIONS: Antegrade sclerotherapy is an intermediate treatment because of its invasive nature and success rate compared with more commonly used percutaneous retrograde sclerosis and Palomo procedures in adolescents. In particular, this method is highly effective and well-accepted by patients with recurrent varicocele.     

Recurrent varicocele: role of antegrade sclerotherapy as first choice treatment

OBJECTIVE: To underline the role of antegrade sclerotherapy as first choice treatment in recurrent varicocele. METHODS: In 53 patients, aged 11-38 years, observed over a 30-month period, antegrade sclerotherapy was carried out for the treatment of recurrent varicocele. In seven of these patients, varicocele was bilateral. The right varicocele, however, had not been previously detected and these patients were, therefore, submitted to simultaneous bilateral antegrade sclerotherapy. RESULTS: Antegrade sclerotherapy was feasible in all 53 patients (60 varicoceles) and no significant complications were observed. Unsuccessful results occurred in only two out of the 55 varicoceles observed over a minimum follow-up period of six months. CONCLUSIONS: Whilst antegrade sclerotherapy is recognized as a low-cost, safe and effective method in the management of varicocele, the success rate in recurrent varicocele is even greater than in primary varicocele. If, in the preceding treatment, the internal spermatic vein has presumably been occluded (percutaneous retrograde sclerotherapy, surgical or laparoscopic retroperitoneal ligation of the entire bundle), antegrade sclerotherapy should be considered the treatment of choice.     

经脐单孔腹腔镜丝线结扎法治疗精索静脉曲张20例报告

目的:探讨经脐单孔腹腔镜下用丝线结扎法治疗精索静脉曲张的疗效. 方法:回顾分析我院采用经脐单孔腹腔镜下丝线结扎法治疗20例精索静脉曲张与24例既往三孔腹腔镜法的临床效果对比. 结果:所有手术均获成功,单孔手术时间20～35 min,平均28 min,术后平均住院时间2d,三孔手术15～28 min,平均20 min,平...     

Recurrent varicocele

Varicocele recurrence is one of the most common complications associated with varicocele repair. A systematic review was performed to evaluate varicocele recurrence rates, anatomic causes of recurrence, and methods of management of recurrent varicoceles. The PubMed database was evaluated using keywords “recurrent” and “varicocele” as well as MESH criteria “recurrent” and “varicocele.” Articles were not included that were not in English, represented single case reports, focused solely on subclinical varicocele, or focused solely on a pediatric population (age <18). Rates of recurrence vary with the technique of varicocele repair from 0% to 35%. Anatomy of recurrence can be defined by venography. Management of varicocele recurrence can be surgical or via embolization.     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张85例报告

目的:探讨腹腔镜精索静脉高位结扎术治疗精索静脉曲张的有效性、安全性及价值。方法:回顾分析我院为85例患者行腹腔镜精索静脉高位结扎术的临床资料。结果:85例手术均获成功,平均手术时间32min,基本无出血,术后平均住院3d。随访3～10个月,3例复发,复发率3.5%。结论:腹腔镜下精索静脉高位结扎术治疗精索静脉曲张具有创伤小、康复快、效果好、并发症少等优点,对双侧精索静脉曲张及开放手术后复发的患者尤有临床价值。     

Low body mass index might be a predisposing factor for varicocele recurrence: a prospective study

We investigated the possible relationship between body mass index (BMI) score and varicocele recurrence in an infertile patient population. A total of 255 primary infertile male patients (138 with varicocele and 117 for control) were included in this study. Height and weight measurements, clinical examination for varicocele, determination of serum hormone levels and spermiogram were performed in all cases. The BMI score was calculated, and patients with varicocele were operated with subinguinal technique and re‐examined for recurrences. The varicocele group had significantly lower weight and the BMI score than the control group (P < 0.001). Varicocele recurrences were found in 22 patients (16% of them) after the operations. The BMI score was significantly lower in the recurrent group than in the nonrecurrent and control groups (P < 0.001). 73% of the recurrent, 50% of the nonrecurrent and 25% of the control group patients' BMI scores were under 25 kg m^?2 (P < 0.001). In logistic regression analysis, the BMI score was found as a determinant for varicocele recurrence (P = 0.027; OR: 1.25). It is concluded that BMI score lower than 25 kg m^?2 significantly increases the recurrence rate after varicocele operation, and it can be used as an objective indicator for microsurgical varicocelectomy.