经颈静脉介入弹簧圈栓塞治疗精索静脉曲张的效果观察

目的观察经颈静脉介入弹簧圈栓塞在精索静脉曲张中的治疗效果。方法对2017年11月至2018年11月山西白求恩医院17例精索静脉曲张患者进行经颈静脉介入弹簧圈栓塞,对其症状、体征及精子质量进行随访观察,评估其疗效。结果 16例患者接受栓塞治疗并随访12个月,阴囊曲张静脉团块明显缩小、会阴部坠胀不适感明显改善,精液质量明显提高,未出现严重的并发症。1例患者因精索静脉解剖变异转入泌尿外科进一步治疗。结论经颈静脉介入弹簧圈栓塞治疗精索静脉曲张操作简便、恢复快、疗效明显、并发症少,值得临床推广。     

导管法无水乙醇栓塞治疗精索静脉曲张

对38例精索静脉曲张患者采用经股静脉穿刺插入漂浮导管行无水乙醇栓塞，效果良好，导管法无水乙醇栓塞治疗精索静脉曲线具有创伤小，并发症少，疗效可靠，门诊病人亦能施行等优点，超选插管技术是栓塞治疗的关键，无水乙醇是简便，可靠的栓塞材料。     

聚多卡醇联合弹簧圈栓塞治疗精索静脉曲张的临床疗效

目的 分析聚多卡醇联合弹簧圈栓塞治疗精索静脉曲张的临床疗效.方法 对2017年2月至2020年2月潍坊医学院附属医院收治的28例精索静脉曲张患者进行经聚多卡醇联合弹簧圈栓塞治疗,观察患者术前及术后静脉反流、精液改善质量情况并随访12个月,评估栓塞治疗效果.结果 28例精索静脉曲张患者均接受栓塞治疗.术后经精索静脉超声检...     

导管引导下泡沫硬化剂治疗精索静脉曲张的疗效分析

目的：探讨泡沫硬化剂栓塞治疗精索静脉曲张（varecocle,VC）的疗效。方法：选择VC患者58例,采用经导管泡沫硬化剂栓塞治疗,对比分析栓塞前后精索静脉主干内径、精液质量的变化,分析其疗效。结果：术后5～30d阴囊坠胀不适等症状消失18例（31．0％）,术后3个月曲张的静脉内径小于1．8mm者48例（82．8％）,大于1．8mm者10例（17．2％）,术后6个月与术前相比,患者精子密度、a＋b级精子活力、精子活动率显著升高,精子畸形率明显降低,两组间差异有统计学意义（P〈0．05）。结论：导管引导下泡沫硬化剂治疗VC疗效确切,能够显著改善VC患者疼痛等不适,提高VC患者精液质量,是一种值得推荐的方法。     

精索静脉曲张复发原因及治疗(附35例报告)

目的：探讨精索静脉曲张复发原因及其治疗。方法：对35例左精索静脉曲张经外科手术结扎或栓塞治疗后复发患者，行左精索静脉造影。结果：35例均发现有迷走血管供血，为迷走供血性精索静脉曲张（AFV）。结论：AFV为精索静脉曲张复发的主要原因。可以通过硬化剂栓塞侧支静脉降低静脉曲张复发率，而对不能栓塞的血管实施联合手术结扎能取得良好疗效。     

腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效观察

目的观察腹腔镜下精索内静脉高位结扎术治疗精索静脉曲张的临床疗效。方法 回顾性分析对精索静脉曲张45例患者采用腹腔镜下精索静脉高位结扎术治疗的临床资料。结果本组患者均顺利完成手术,手术时间30～60 min,平均40 min。术后左阴囊气肿2例,反应性睾丸鞘膜积液1例,阴囊坠胀不适感2例,均未做任何处理,2 d内自行消退。所有患者精索静脉曲张症状均消失或明显改善,无复发和睾丸萎缩。结论腹腔镜精索静脉高位结扎术治疗精索静脉曲张创伤小、复发率低,必将彻底代替传统的开放性手术。     

经腹股沟和经腹股沟下途径显微镜精索静脉结扎术的疗效对比

目的比较经腹股沟和经腹股沟下途径显微镜精索静脉结扎术治疗精索静脉曲张的安全性和疗效。方法回顾性分析我院2016年1月至2019年6月显微镜精索静脉结扎术治疗精索静脉曲张145例资料,经腹股沟途径53例,经腹股沟下途径92例。比较两组手术时间、结扎精索静脉数量、阴囊疼痛缓解率、精子质量改善情况及并发症(睾丸鞘膜积液、睾丸萎缩、复发)。结果经腹股沟途径手术比经腹股沟下途径手术时间短[(34.2±5.0)min vs(37.8±8.4)min,t=–3.245,P=0.001],且结扎精索内静脉数量少[(6.1±1.3)根vs(8.3±1.5)根,t=–9.171,P<0.001]。两组术后精子质量改善情况、阴囊疼痛缓解率及并发症发生率差异无统计学意义。结论显微镜下经腹股沟和经腹股沟下途径精索静脉结扎术治疗精索静脉曲张均疗效确切而且安全。经腹股沟途径需结扎的精索内静脉少,手术时间短。     

微型腹腔镜一孔法治疗精索静脉曲张

目的介绍一孔法微型腹腔镜精索静脉结扎术治疗精索静脉曲张的手术方法,探讨其临床应用价值。方法采用一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张20例,单侧病变17例,双侧病变3例。结果单侧精索静脉曲张手术时间平均为12（10～20）min,双侧病变患者手术时间约为23（20～30）min。患者术后疼痛轻微、均无需镇痛,平均住院时间2.6（2～4）d。均获随访,时间1～9个月,未见复发、阴囊气肿、阴囊水肿、鞘膜积液、睾丸萎缩等并发症。结论一孔法微型腹腔镜精索高位结扎术治疗精索静脉曲张疗效可靠,更具有微创、安全、美观的优点。     

显微精索静脉结扎术对阴囊疼痛不适及不育的疗效对比分析

目的:对比分析显微精索静脉结扎术对阴囊疼痛不适及不育情况的改善率。方法:2011年3月~2012年12月采用显微精索静脉结扎术治疗2~3度精索静脉曲张患者88例,其中左侧精索静脉曲张66例,双侧精索静脉曲张22例。49例(55.7%)主诉为患侧阴囊疼痛不适,39例(44.3%)主诉为不育。阴囊疼痛不适患者使用视觉模拟评分法评估手术效果,不育患者评估精液质量及配偶自然妊娠情况。结果:术后1年随访,33例患者(67.3%)疼痛完全缓解,18例患者(46.2%)配偶已自然妊娠。疼痛完全缓解率与配偶自然妊娠率的差异有统计学意义(P0.05)。结论:显微精索静脉结扎术是治疗精索静脉曲张所致阴囊疼痛不适及男性不育的有效方法,其中阴囊疼痛不适患者手术效果较不育患者更佳。     

一孔法微型腹腔镜精索静脉高位结扎术

目的介绍一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张的手术方法,探讨其临床应用价值。方法采用一孔法微型腹腔镜精索静脉高位结扎术治疗精索静脉曲张11例,年龄19～45岁,平均26岁,病程1个月至5年,单侧病变9例,双侧病变2例。结果单侧精索静脉曲张手术时间为10～20min,平均12min,双侧病变患者手术时间为1例20min,1例30min,平均25min。患者术后疼痛轻微、均无需使用止痛药,平均住院时间2．7d,随访1-3个月未见复发、阴囊气肿、阴囊水肿、鞘膜积液、睾丸萎缩等并发症。结论一孔法微型腹腔镜精索高位结扎术治疗精索静脉曲张疗效可靠,具有微创、安全、美观的优点。     

Percutaneous embolization of varicocele: technique,indications, relative contraindications,and complications

There are several options for the treatment of varicocele, including surgical repair either by open or microsurgical approach, laparoscopy, or through percutaneous embolization of the internal spermatic vein. The ultimate goal of varicocele treatment relies on the occlusion of the dilated veins that drain the testis. Percutaneous embolization offers a rapid recovery and can be successfully accomplished in approximately 90% of attempts. However, the technique demands interventional radiologic expertise and has potential serious complications, including vascular perforation, coil migration, and thrombosis of pampiniform plexus. This review discusses the common indications, relative contraindications, technical details, and risks associated with percutaneous embolization of varicocele.     

Treatment of bleeding varicose veins of the scrotum with percutaneous coil embolization of the left spermatic vein: a case report

Percutaneous coil embolization of the spermatic vein offers a minimally invasive method for treating symptomatic varicose veins of the scrotum. We describe the case of a 63-year-old man with multiple comorbidities and persistent bleeding from scrotal varicosities. Venography revealed significant left spermatic vein reflux and a large left varicocele. Percutaneous coil embolization of the left spermatic vein completely resolved the bleeding from the left side of the patient's scrotum. Although many vascular specialists possess the technical skills to perform this procedure, they may not be familiar with its use in the treatment of scrotal varicosities and varicoceles.     

改良Palomo术与静脉栓塞术治疗精索静脉曲张的疗效分析

目的 通过改良Palomo术与介入栓塞治疗精索静脉曲张的临床对比,探讨两者之间的优劣性。方法 234例患者随机分为两组,改良Palomo术高位结扎组117例,介入栓塞组117例,随访3～6个月,分别就手术时间、术中出血、住院时间、医疗费用方面、并发症发生率、复发率等方面进行比较。结果 两组病例对比观察,手术时间分别为3...     

Spermatic vein embolization as a treatment for symptomatic varicocele

IntroductionVaricocele is a relatively common condition in men that causes pain in approximately 10% of cases. There have been few studies to date assessing the improvements in both pain and quality of life parameters associated with spermatic vein embolization (SVE) as a treatment for patients with symptomatic varicocele, so we aimed to assess this.MethodsA review was carried out of consecutive SVE procedures performed at our institution from 2013–2019. Only patients with painful varicocele were included after other causes of testicular pain were excluded. The technique employed was a combination of distal coil embolization of the spermatic vein with 4–6 mm coils at the level of the inguinal canal, as well as sclerotherapy to prevent reflux of sclerosant. Furthermore, a prospective validated Pain Impact Questionnaire-6 (PIQ-6) was performed to assess for improvement in quality of life. A matched pair Student two-tailed t-test was used to compare mean scores pre- and post-treatment, with 95% confidence intervals presented as T scores and their associated p-values.ResultsOver six years, 62 SVE procedures were performed for symptomatic varicocele. Success rate was 95%, with a median followup of nine months. Two patients had a failed procedure on two occasions requiring subsequent surgical ligation. There was one clinically significant recurrence. All components of PIQ-6 score showed a statistically significant reduction post-SVE, most noticeably pain severity and impact on leisure activities.ConclusionsSVE is a safe, effective, and well-tolerated treatment for symptomatic varicocele, improving pain and quality of life.     

Varicocele treatment: prospective randomized trial of 3 methods.

This study was done to evaluate the surgical results and the impact on fertility potential of 3 methods of varicocele treatment. Consecutive varicocele patients with primary or secondary infertility were randomly assigned to 3 treatment groups. Of the patients 36 underwent percutaneous embolization, 55 high ligation of the internal spermatic vein and 28 transinguinal simultaneous ligation of the internal and external spermatic veins. The transinguinal ligation proved to be safe. There was no difference in pregnancy rates but the seminal variables showed a slight improvement with statistical significance only in the 2 open surgical methods. There were no surgical failures in the transinguinal group as opposed to the other 2 techniques. Transinguinal ligation of the internal and external spermatic veins may be recommended as the primary treatment for varicocele. This technique also seems to be the procedure of choice when repeat intervention is required for failure of high ligation or embolization.     

Endovascular coil embolization of unusual posterior inferior cerebellar artery aneurysms

Three patients underwent transarterial platinum coil embolization of unusual posterior inferior cerebellar artery aneurysms. In one case, a giant, bilobed, partially thrombosed aneurysm exhibited marked mass effect on the adjacent medulla. In the second case, diffuse severe cerebral vasospasm, 3 days after subarachnoid hemorrhage, rendered transvascular treatment of the aneurysm difficult. Increasing vertigo and nausea caused by mass effect from an aneurysm previously coated with methyl methacrylate warranted treatment in the third case. Indications for transvascular coil treatment included relative surgical inaccessibility to the aneurysm, and, in our case, inability to perform transarterial detachable balloon therapy. The aneurysms were obliterated by endovascular coil embolization in each case. In the patient with vasospasm, aneurysm treatment followed angioplasty of the major affected cerebral vessels, resulting in significant neurological improvement within 24 hours. Two patients were neurologically intact at the time of discharge, and the third displayed persistent cerebellar signs despite a marked decrease in vertigo and nausea. Reports of transvascular coil embolization of intracranial aneurysms are very rare. Our experience with these patients demonstrates that this technique can be successfully utilized in selected cases.     

Retrograde venography and embolization in postoperative recurrence of varicocele

Percutaneous retrograde venography was performed in 10 patients with recurrent varicocele after surgical ligation (the Ivanissevich operation) of the spermatic vein. Combined scleroembolization with Thrombovar plus steel coils was performed in 8 patients. In two other patients either sclerotherapy or embolization only was made depending on their anatomical peculiarities. No recurrences were seen during 6-60 months of follow-up in 9 patients in whom the occlusion of all venous feeders was technically successful. It was concluded that embolization was a minimally invasive and effective procedure and hence the transcatheter treatment should be considered a method of choice for post-surgical recurrent varicocele.     

A Novel Method for Super-selective Coil Embolization Using an Extremely Soft Bare Coil through a Liquid Embolic Delivery Microcatheter

Endovascular coil embolization for intracranial aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistulas (AVFs), and hypervascular tumors are recognized as an effective adjunctive or curative treatment. In this setting, it is sometimes difficult to navigate a coil delivery microcatheter to the target point of a tiny, tortuous vessel. We herein present a case series of a novel method that enabled super-selective coil embolization using an extremely soft bare, electrodetachable coil (ED extrasoft^® coil) through a liquid embolic delivery microcatheter (Marathon^®). The Marathon^® catheter was successfully placed at the target point of the tiny, tortuous vessel, and coil embolization was achieved in all 16 patients with 9 AVMs, 2 distal aneurysms, 2 AVFs, and 3 meningiomas. The primary ED extrasoft^® coil and delivery wire have a very small radius, and the coil is rapidly detachable with an alarm notice from the generator even under Marathon^® with one marker. We believe that this technique can provide safe and efficient embolization for selected patients.     

弹簧圈栓塞治疗颅内微小动脉瘤及中长期随访

目的评价弹簧圈栓塞治疗颅内微小动脉瘤（VSCAs）的有效性及稳定性。方法 19例患者（20枚VSCAs）接受血管内弹簧圈栓塞治疗。对其中9枚动脉瘤使用单纯弹簧圈栓塞,9枚使用支架辅助弹簧圈栓塞,2枚使用球囊辅助弹簧圈栓塞。根据DSA表现,将栓塞程度分为完全栓塞、次全栓塞和部分栓塞。术后进行中长期随访并收集DSA及临床结果。结果所有VSCAs均获成功栓塞。术后即刻DSA显示,20枚VSCAs中5枚为完全栓塞,9枚为次全栓塞,6枚为部分栓塞。1~2年随访DSA示20枚VSCAs均完全栓塞,未发现动脉瘤复发及弹簧圈脱出、移位。临床随访显示所有患者均未出现动脉瘤再次破裂出血及神经系统缺血症状。结论血管内弹簧圈栓塞治疗VSCAs有效、稳定;中长期随访证实次全及部分栓塞的患者可发展为完全栓塞。