Tosato F, Passaro U, Vasapollo L, Carnevale L, Scocchera F, Marano S, Tosato M, Martone N, Paolini A
Dipartimento di Scienze Chirurgiche e Tecnologiche Mediche Applicate, Università degli Studi di Roma, La Sapienza.
Minerva Chir. 2000 Apr;55(4):283-8.
Purpose of the paper is to sum up the problem of surgery of idiopathic varicocele according to the present possibilities, both surgical and sclerotic. A wide review of the literature underlines a high rate of relapses and persistence of the disease (with a percentage from 10 to and 10%) following the two most used technique: retrograde sclerotic therapy under radioscopic control and surgical retroperitoneal or inguinal ligature of the internal spermatic vein; this technique was preferred by us until 1997. The percentage of failures, high with reference to the benign form of the disease (over 10% in our series of more than 100 patients submitted to clinical and flow-meter examinations) let the authors suggest a combined and simultaneous operation of ligature both internal and external of the spermatic vein at the level of the internal inguinal ring. Anatomical reasons confirm the opportunity of this procedure since the involvement of the system of the external spermatic vein is present in about the 20% of the cases of idiopathic varicocele in accordance with various flebografic studies. The possibility of escape through the external spermatic vein is eliminated in the case in which such vessel is preserved, and it seems frequent above all in 3rd degree idiopathic varicocele where many anastomotic vessels between the two systems are present. This procedure can be made both in general or local anaesthesia, it doesn't involve postoperative hospital stay and present the same acceptable postoperative complication of other proposed operations. The laparoscopic treatment even if easily performed at the level of the internal inguinal ring, doesn't seem justified for the higher cost and equal compliance for the patient. Besides, it is not possible to proceed laparoscopically under local anaesthesia.
本文的目的是根据当前手术和硬化治疗的可能性，总结特发性精索静脉曲张的手术问题。对文献的广泛回顾强调，在两种最常用的技术（放射镜控制下的逆行硬化治疗以及手术进行腹膜后或腹股沟内环处精索内静脉结扎）之后，疾病的复发率和持续存在率很高（百分比从10%到10%不等）；在1997年之前我们更倾向于这种技术。相对于该疾病的良性形式而言，失败率较高（在我们超过100例接受临床和流量计检查的患者系列中超过10%），这使得作者建议在腹股沟内环水平同时进行精索内静脉和精索外静脉的结扎联合手术。解剖学原因证实了该手术的合理性，因为根据各种静脉造影研究，约20%的特发性精索静脉曲张病例存在精索外静脉系统受累情况。在保留该血管的情况下，消除了通过精索外静脉逃逸的可能性，这在三度特发性精索静脉曲张中似乎尤其常见，因为两个系统之间存在许多吻合血管。该手术可在全身麻醉或局部麻醉下进行，无需术后住院，且术后并发症与其他建议手术相当。腹腔镜治疗即使在内环水平易于操作，但由于成本较高且患者依从性相同，似乎并不合理。此外，无法在局部麻醉下进行腹腔镜手术。
