腹腔镜高位结扎与介入栓塞治疗精索静脉曲张的临床对比观察

目的通过腹腔镜高位结扎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221例患者随机分为两组,腹腔镜高位结扎组112例,介入栓塞组109例,随访3年,分别就治疗过程、手术效果、并发症等方面进行比较。结果两组病例在对比观察项目的依从性、手术时间、止痛剂使用、症状近期缓解程度4方面无显著性差异,在住院时间和并发症方面有差异性（P〈0.05）,而在围手术时间、失败率、总费用有显著性差异（P〈0.01）。结论综合比较,精索静脉曲张介入栓塞术优于腹腔镜精索静脉高位结扎术。     

静索静脉曲张的治疗——高位结扎还是低位结扎

为提高精索静脉曲张结扎术疗效,减少术后复发,采用经外环精索静脉集束结扎术治疗精索静脉曲线65例68侧,选内环上方的腹膜后精索内静脉结扎术患者52例54侧作比较,彩色多普勒超声检查两组精索静脉反流并分级,随访两组的术后复发率。结果表明两组术前彩色多普勒超声检查阴囊根部精索内静脉反流均为Ⅱ～Ⅲ级,经外环精索静脉集束结扎治疗组术后经彩色普勒超声检查静脉反流0级64侧、Ⅰ级4侧,随访术后复发1例;腹膜后精索内静脉结扎组术后经彩色普勒超声检查静脉反流Ⅰ度30例、Ⅱ度14例,随访术后8例复发。认为经外环集束结扎法治疗精索静脉曲张,可避免漏扎平行腹股沟的侧支静脉,切口低、表浅,操作方便,效果确切,是精索静脉曲张的主要治疗方法。     

Ambulatory treatment of varicocele

The authors describe their experience in the ambulatory treatment of varicocele. Forty-four patients were treated through an infrapubic approach and only one recurrence was observed. The authors conclude that ambulatory treatment of varicocele is safe, easy to perform and the patient can resume his daily activity within 48–72 h.     

Microsurgical treatment of varicocele

The authors report their experience of the surgical treatment of varicocele. After having performed modified Palomo's method for many years, recent pathogenetic data have induced them to adopt a microsurgical technique. This technique involves vascular anastomoses which allow drainage of the testicular blood into an area with lower venous pressure. They used Fox's technique (anastomosis between 2-3 veins of the pampiniform plexus and saphena vein) and Belgrano's technique (anastomosis between internal spermatic vein and inferior hepigastric vein). The authors report their series of 30 patients treated with these techniques between 1984 and 1987. The results obtained from 20 who were followed-up one year after surgery demonstrated an improvement in the physical examination in 70% of cases and a decreases in hyperthermia in 75% of patients. A spermiogram improvement has been obtained in 66.6% of 18 patients, as two of them were of pediatric age.     

Non-operative treatment of varicocele

Thirty-eight patients with 40 varicoceles underwent spermatic venography and 27 varicoceles were treated by transvenous embolization under local anaesthesia as an outpatient procedure. The indications for the procedure were infertility (21), swelling (3), pain and discomfort (9) and asymptomatic varicoceles (5).     

Laparoscopic treatment of varicocele

The Authors present their experience on the treatment of the varicocele; they performed laparoscopic clamping of the internal spermatic vein in 12 subfertile patients, utilizing only the bipolar coagulation without the use of clips. All patients were available for follow-up, which ranged from 6 to 12 months, including physical examination, Doppler C.W. and study of semen quality. Recurrence of varicocele was not observed, the semen quality demonstrated improvement in semen motility in 9 patients (75%) and normal on 3 patients (25%). The use of bipolar coagulation with smaller ports (phi 5 mm) resulted in less postoperative pain and shorter convalescence than when larger ports were used (phi 10 mm). The Authors conclude that the laparoscopic procedure, used as they do, is safe and costs less than classic ligation with clips as well as radiological occlusion procedures.     

Percutaneous treatment of varicocele

Varicocele is a common finding in adolescents and adult men. Its association with male infertility has been well documented: varicoceles are reported to be present in 20-40% of infertile men. It has been demonstrated that varicocele correction leads to an improvement in the quality of semen in most cases. Percutaneous sclerotherapy is an established treatment method for varicocele performed on an outpatient basis. In our report we review our experience with venographic study and transcatheter sclerotherapy based on 560 cases of infertile patients with varicocele. Our study confirms that percutaneous therapy of varicocele may lead to improved spermatogenesis in the majority of patients.     

改良Palomo术治疗精索静脉曲张的疗效分析

目的：探讨精索静脉曲张（Vc）患者行改良Palomo术的疗效,分享手术经验。方法：2009年7月～2012年1月采用改良Palomo术治疗伴有精液质量下降的VC患者182例,观察手术治疗后精液参数的变化及配偶自然受孕情况。结果：182例手术均获得成功。手术前后精液质量经统计学分析,差异有统计学意义（PdO．01）,术后精液质量明显改善;不育患者配偶自然受孕率为54．55％（84／154）,均未出现阴囊水肿及睾丸萎缩,均未复发。结论：改良Palomo术对伴有精液质量下降的VC患者效果良好,且对不育也有很好的疗效。     

Surgical treatment of varicocele

Varicocele as a major cause of male infertility has been well established. Increasing numbers of this operation are being performed yearly. We describe a simple technique utilizing local anesthesia which significantly reduces the risks of the operation and hospital stay. Its impact on cost effectiveness is discussed.     

Current methods of the treatment of varicocele

The results of complex examination and treatment of 172 patients with varicocele are presented. Roentgenoendovascular occlusion of the testicular vein was performed in 52 patients with the positive result in 43 of them. The disease recurrence was revealed in control examination 6 mos later in 9 patients. A new microsurgical operation of creating the double spermatico-venous++ anastomosis, which permits to accomplish the more complete correction of venous hemodynamics in the system of the testicular vein, to reduce the traumatism of the operation, to improve the conditions for normalization of spermatogenesis, is suggested. A recurrence of varicocele after its treatment by means of the microsurgical correction occurred in 1 patient. Of the 56 women, whose husbands suffered from infertility, after microsurgical operations performed for varicocele, the pregnancy resulted in 19.     

Medical and surgical treatment of varicocele

OBJECTIVES: Varicocele is a dilation of the pampiniform venous plexus in the spermatic cord. It appears in 15% approximately of general population males. It is the most commonly identifiable, surgically treatable lesion associated with male infertility. The surgical treatment of varicocele, either unilateral or bilateral, has demonstrated a significant improvement in seminal parameters at least in two-thirds of affected males, and 30% to 60% pregnancy rates. There are many controversies about the indication of surgical treatment, more popular than percutaneous embolization, because several series have not demonstrated clear benefit; nevertheless, most authors support surgery, because its low morbidity, it is easy to perform, has a rapid adaptation process, and improves seminal parameters in most cases, or at least prevents their progressive impairment observed when surgery is not performed.     

精索筋膜肌管折叠术治疗精索静脉曲张及远期随访

１９７６年７月至１９８７年１月采用精索筋膜肌管折叠术治疗精索静脉曲张２７例（２９侧）。２０例２２侧平均随访１３６．１个月，静脉曲张均消失，随访４例合并不育症者３例已育，１例术前无精子者恢复了生育力，介绍了手术方法及精索筋膜肌管的解剖及组织和形态学研究结果。     

精索静脉曲张的治疗方法探讨

目的探讨腹腔镜、经腹股沟管和经腹膜后3种方法高位结扎精索静脉治疗精索静脉曲张的临床应用价值。方法回顾近6年精索静脉曲张患者130例，均为单侧首次治疗，其中腹腔镜手术19例（I组），经腹股沟管手术61例（Ⅱ组），经腹膜后手术50例（Ⅲ组）。结果Ⅰ组手术3个操作通道皮肤切口共长约3cm，Ⅱ组和Ⅲ组手术切口约3-5cm。3种手术平均手术时间分别为35、40、28min，平均住院费用分别为6500元、2280元、2160元，术后阴囊肿胀发生率分别为10．5％（2／19）、16．4％（10／61）、0％（0／50），睾丸萎缩发生率分别为0％（0／19）、4．9％（3／61）、0％（0／50）。腹腔镜手术术后阴囊皮下气肿发生率21．1％（4／19），脐部感染发生率5．5％（1／19）。术后随访1年治愈率分别为94．7％（18／19）、78．7％（48／61）、96％（48／50）。Ⅰ组手术住院费用、Ⅲ组术后阴囊肿胀发生率、Ⅱ组术后1年治愈率与其他两组比较差异有统计学意义（P〈0．05）。3种方法手术时间、术后睾丸萎缩发生率比较差异无统计学意义（P〉0．05）。结论经腹膜后高位结扎精索静脉是单侧精索静脉曲张的首选治疗方法。