腹腔镜下高位结扎精索静脉治疗精索静脉曲张30例

19961998年,我院采用腹腔镜高位结扎精索静脉治疗精索静脉曲张30例,随访612个月,疗效确切。1　临床资料11　一般情况　年龄1725岁,平均205岁。均为左侧精索静脉曲张,有患侧阴囊坠胀感,行走或运动后加重。静脉曲张中度(触诊即可摸到曲张静脉,但外观正常)22例,重度(曲张静脉如成团蚯蚓,触诊及视诊均极明显)8例。术前均行Ｂ超检查,排除左肾和腹膜后占位者、积水等继发性原因。中度静脉曲张2例为常规手术6个月后复发。12　手术方法　采用美国ＣＩＲＣＯＮ腹腔镜及手术器械,术前1ｄ口服番泻叶行肠道准备,术晨禁食,常规消毒术野皮肤,采用连续硬膜…     

顺行精索静脉栓塞治疗精索静脉曲张126例

1996～ 1 999年 ,我院采用顺行精索静脉栓塞术治疗精索静脉曲张 1 2 6例 ,效果满意。1　临床资料1 1　一般情况　 1 2 6例中 ,年龄 1 8～ 4 6岁 ,平均 2 6 8岁。左侧精索静脉曲张 1 0 2例 ,双侧 2 4例。以吴阶平[1] 分度标准 :Ⅰ度 2 6例 ( 2 0 6% ) ,Ⅱ度 68例( 53 9% ) ,Ⅲ度 32例 ( 2 5 5% )。病程 0 5～ 1 2年 ,平均 3 6年。精索静脉高位结扎术后复发 1 8例 ;婚后不育 2 6例。精液质量检查 :精液量 3 2 6± 1 36ｍｌ,精子活动率 2 3 4 5± 1 6 50 % ,精子密度 ( 56 68± 4 86)×1 0 6/ｍｌ。1 2　治疗方法　阴囊消毒后 ,用 1 %普…     

外环精索静脉集束结扎治疗精索静脉曲张103例

1999～ 2 0 0 2年 ,我院在局麻下行外环精索静脉集束结扎术 10 3例 ,效果良好。1　临床资料1 1　一般情况　 10 3例 (10 6侧 )中 ,年龄 18～ 35岁 ,平均2 2 3岁。左侧 10 0例 ,双侧 3例。Ⅱ度 4 7侧 ,Ⅲ度 5 9侧。伴不育 2例。均经Apogec 4 0 0型彩色多普勒超声检查示静脉反流Ⅱ～Ⅲ级。1 2　方法　取平卧位 ,常规消毒术区铺巾 ,选腹股沟管中央位置局部推注利多卡因 2 0～ 30ml,局麻起效后切开皮肤约3 0cm及皮下、筋膜 ,找出精索 ,打开精索外筋膜、提睾肌、精索内筋膜 ,分离出精索动脉及输精管 ,将曲张的精索静脉及其余组织集束双重结扎。…     

介入栓塞治疗精索静脉曲张疗效观察

精索静脉曲张好发于男性青壮年，左侧多见。症状轻者可保守治疗，症状重者常规采用精索内静脉高位结扎术。我院自1999年至今共收治精索静脉曲张病人24例，应用钢丝圈加无水乙醇介入永久栓塞术治疗，术前通过彩色多普勒超声及选择性逆行静脉造影确诊，术后随访2—3年，症状体征消失，无并发症发生，现将24例报告如下：     

腹腔镜精索静脉高位结扎术治疗精索静脉曲张的疗效分析

目的观察腹腔镜精索静脉高位结扎术治疗精索静脉曲张患者的疗效。方法128例原发性精索静脉曲张患者,均经Valsalva试验及阴囊彩色多普勒超声检查证实精索静脉曲张并见反流征,术前精液分析均有不同程度的异常改变。采用腹腔镜精索静脉高位结扎术进行治疗。结果手术顺利,平均手术时间23.9 min,出血量平均约2 mL,无术中并发症发生,平均住院时间2.8 d。术后3个月精液质量明显改善,无复发。结论腹腔镜精索静脉高位结扎术治疗精索静脉曲张具有损伤小、恢复快、并发症少、效果满意的优势,值得临床推广应用。     

腹腔镜下精索静脉高位结扎术治疗精索静脉曲张

目的：探讨腹腔镜下精索静脉高位结扎术治疗精索静脉曲张的临床经验。方法：回顾性分析120例腹腔镜精索静脉高位结扎术的治疗效果及恢复情况。结果：120例手术后均获得满意的临床效果。结论：腹腔镜精索静脉高位结扎术具有简便、微创、并发症少、效果可靠及恢复快等优点，是治疗精索静脉曲张的一种有价值的方法。     

腹腔镜下精索内静脉高位结扎治疗精索内静脉曲张的应用

我院于2005年12月～2008年11月经腹腔镜下精索内静脉高位结扎治疗原发性精索静脉曲张26例,现报道如下。     

选择性精索静脉造影29例X线分析

自1982年12月至1985年6月，我院采用经右股静脉插管行选择性精索静脉造影诊断精索静脉曲张共29例，其中22例成功，7例失败，均经手术证实，术后造影8例，造影诊断可靠，方法简便易行，现扼要分析如下。     

精索静脉曲张手术失败的腹腔镜再治疗体会

目的：探讨经腹腔镜治疗精索静脉曲张的疗效及价值。方法：对10例精索静脉曲张开放手术失败后经腹腔镜再治疗病例进行回顾性总结分析。结果：10例均获成功，平均手术时间15min，术后平均住院3d；全部随访6～18个月，无1例复发。其中3例不育症患者术后10-12个月后其妻怀孕。结论：腹腔镜精索内静脉高位结扎术疗效可靠，对开放性手术后复发、双侧精索静脉曲张和有腹股沟区手术史者尤为实用，值得推广应用。     

A Proposed Anatomic Typing of the Right Internal Spermatic Vein: Importance for Percutaneous Sclerotherapy of Varicocele

Purpose To classify the anatomic types of the right internal spermatic vein (ISV). Methods We evaluated venograms obtained in 150 consecutive patients with idiopathic varicocele referred for transfemoral sclerotherapy. Results Six anatomic types of the right internal spermatic vein (ISV) were recognized. These were classified by the location of their orifices and the tributary venous patterns. In roughly half the patients (53%), the ISV appeared as a simple vein with no remarkable retroperitoneal interconnections. In the remainder, complex retroperitoneal anastomoses were encountered. Conclusion By understanding these anatomic variations, the angiographer can approach treatment of right-sided varicocele with foreknowledge of the nature of these types and the presence of valves and collaterals.     

Transcatheter Foam Sclerotherapy of Symptomatic Female Varicocele with Sodium-Tetradecyl-Sulfate Foam

To evaluate the efficacy of transcatheter foam sclerotherapy (TCFS) in pelvic varicocele using sodium-tetradecyl-sulfate foam (STSF), we conducted a retrospective study in 38 patients (mean age, 36.9 years; range, 22–44 years) with pelvic congestion syndrome (PCS) treated between January 2000 and June 2005 by TCFS. Pelvic pain was associated with dyspareunia in 23 (60.5%) patients, urinary urgency in 9 (23.7%) patients, and worsening of pain during menstruation and at the end of a day of work in 7 (18.4%) and 38 (100%) patients, respectively. Diagnosis was made by pelvic and transvaginal color Doppler ultrasound examination, demonstrating ovarian or pelvic varices with a diameter >5 mm presenting venous reflux. TCFS was performed in all patients, using 3% STSF. Follow-up was performed by physical examination, pelvic and transvaginal Doppler ultrasound examination and by a questionnaire-based assessment of pain at 1, 3, 6, and 12 months after the procedure. Technical success was achieved in all patients (100%). In three patients a pelvic colic-like pain occurred immediately after sclerotic agent injection, disappearing spontaneously after a few minutes. No recurrent varicoceles were observed during a 12-month follow-up. A statistically significant improvement in each category of specific symptoms was observed at 1, 3, 6, and 12 months after the procedure. We conclude that TCFS of female varicocele using a 3% STSF is safe and effective for the treatment of PCS. It is associated with a significant reduction of symptoms and can be regarded as a valid alternative to other endovascular and surgical techniques.     

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

Objective

To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries.

Materials and Methods

From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits.

Results

A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found.

Conclusion

Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.     

Percutaneous Treatment of Congenital Splenic Cysts: Drainage and Sclerotherapy with Polidocanol

Congenital “true” splenic cysts are rare lesions. Therapeutic methods for the management of these lesions have been based on preserving splenic function due to the immunologic role of spleen. We report three different cases of congenital splenic cysts treated by percutaneous drainage and polidocanol sclerotherapy. This less invasive treatment appears to be safe and effective after 6 to 36 months of follow-up.     

Venous malformations: Sclerotherapy with a mixture of ethanol and lipiodol

Purpose To evaluate the usefulness of a mixture of absolute ethanol and lipiodol in the management of venous malformations. Methods Percutaneous sclerotherapy was performed with a mixture of absolute ethanol and lipiodol (9∶1) in 17 patients with venous malformations, once in 12 patients, twice in 5. The therapeutic efficacy was evaluated by pain reduction. Conventional radiographs (n=15) and posttreatment magnetic resonance imaging (n=5) were obtained for the follow-up evaluation. Results Sclerotherapy was successful in all but two patients. The therapeutic effect was excellent in two patients, good in seven, fair in five, and poor in one. Radiopacity of lipiodol was beneficial for monitoring the procedure rather than for follow-up evaluations. Areas with low signal-intensity strands were increased on T2-weighted images obtained after the sclerotherapy. Conclusion Sclerotherapy with a mixture of ethanol and lipiodol is effective in treating venous malformations.     

彩色多普勒超声在诊断精索静脉曲张中的应用

目的：探讨彩色多普勒超声诊断男性不育症患者精索静脉曲张的检测指标及精索静脉曲张导致睾丸变小的情况。方法：采用彩色多普勒超声对46例正常对照者的精索静脉及178倒男性不育患者左侧曲张的精索静脉进行了检测。结果：①健康对照组双侧平静呼吸时精索静脉最大内径（DR）、Valsalva试验时精索静脉最大内径（D。）、最大返流速度（Vmax）、返流持续时间（TR）及睾丸体积差别均无显著性意义（P〉0．05）;②精索静脉曲张组与对照组及各级精索静脉曲张组间DR、DV、VR比较的差别具有显著性意义（P〈0．001）;③各精索静脉曲张组左侧睾丸体积小于右侧（P〈0．01）及对照组（P〈0．001）,精索静脉曲张Ⅱ、精索静脉曲张Ⅲ组右侧睾丸体积小于对照组（P〈0．05）,精索静脉曲张Ⅲ组左侧睾丸体积小于亚临床型精索静脉曲张组（P〈0．05）。结论：①彩色多普勒超声可为男性不育精索静曲张患者提供精确的精索静脉内径、血流动力学及睾丸大小等客观指标,有助于男性不育症病因的筛选;②单侧精索静脉曲张可引起双倒睾丸体积变小,以左侧为甚,亚临床型及临床型精索静脉曲张均可导致患侧睾丸体积缩小,且精索静脉曲张愈严重,睾丸体积愈小。     

Ethanol Sclerotherapy for the Management of Craniofacial Venous Malformations: the Interim Results

Objective

We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs).

Materials and Methods

From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients.

Results

A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop.

Conclusion

Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.     

经导管血管栓塞术对精索静脉曲张患者血浆性激素水平的影响

目的 探讨经导管精索静脉栓塞术对精索静脉曲张患者血浆性激素水平的影响,并分析精液与血浆性激素变化之间的关系.资料与方法 对37例Ⅱ度以上且伴有精液异常的精索静脉曲张患者使用鱼肝油酸钠加明胶海绵颗粒行选择性精索静脉栓塞术.分别于术前及术后12个月测定血浆卵泡刺激素(FSH)、黄体生成素(LH)和睾酮(T),并进行精液分析.结果 37例患者的总体FSH水平从术前的(17.33±6.54) IU/L降低至术后的(10.83±4.93) IU/L(P<0.01),总体LH水平从术前的(15.26±6.04) IU/L降低至术后的(9.57±4.33) IU/L(P<0.01),总体T水平从术前的(13.56±6.74) nmol/L升高至术后的(18.37±7.37) nmol/L(P<0.01),精子密度从术前的(14.37±8.61)×106/ml增加至术后的(50.56±20.16)×106/ml,精子活力从术前的(18.05±3.83)%增加至术后的(37.13±7.21)% (P<0.01).术后精子密度、精子活力与术前相比有显著提高(P<0.01).20例术前性激素水平异常者的术后FSH、LH平均水平高于17例术前血浆性激素水平正常者(P<0.05),术前性激素水平异常者的术后T低于术前血浆性激素水平正常者(P<0.01);术前性激素水平异常者的术后精子密度低于术前血浆性激素水平正常者(P<0.01).结论 经皮精索静脉栓塞术对血浆FSH、LH、T产生了影响,继而可提高精索静脉曲张患者的生育能力.     

彩超对精索静脉曲张的诊断价值

目的探讨彩超对精索静脉曲张（VC）的诊断及对临床制定治疗方案的价值。方法回顾性分析73例经彩超诊断的精索静脉曲张患者声像表现，根据有无反流将其分为有反流组和无反流组，并将患侧与健侧作比较，诊断结果与手术对照。结果在平静呼吸时，两组间扩张的静脉内径无显著性差异（P〉0．05），在作Valsalva呼吸时，则有显著性差异（P〈0．05），有反流组内径大于无反流组；平静呼吸及Valsalva呼吸时，患侧精索静脉内径均大于健侧（P〈0．05）。与手术结果对照，彩超对VC的诊断符合率为100％。结论彩超是诊断VC的首选检查，有、无反流的分型对选择手术方式有重要参考意义。     

导管法栓塞曲张的精索静脉

对曲张的精索静脉采用Seldinger方法行鱼肝油酸钠栓塞13例,成功11例。免除了手术痛苦,术后10～24个月复查无复发。文章讨论了几种栓塞材料的优缺点及栓塞与手术法进行了比较。