Cordovana A, Scafella A, Gaeta F, Confalonieri M, Pisani Ceretti A, Del Re L
Cattedra di Clinica Chirurgica I, Scuola di Specializzazione in Chirurgia Generale, Ospedale Policlinico, Milano.
Minerva Chir. 2000 Nov;55(11):751-7.
Varicocele is found approximately in 15% of the male population and is considered a major cause of infertility. Varicocele management include surgical (traditional or laparoscopic) or conservative techniques (sclerotherapy). The authors present their experience on microsurgical inguinal varicocelectomy. This technique has been adopted since 1992 to decrease the incidence of recidives of high spermatic vein ligation; it also permitted to use local or loco-regional anesthesia, reducing time of hospitalization and realizing a minimally invasive approach.
From 1992 to 1997, 433 microsurgical inguinal varicocelectomy with artery and lymphatic sparing have been performed at the Militar Hospital of Milan in 409 young men with idiopathic varicocele. All patients were discharged 24 hours after operation. Only those who lived particularly far from the hospital remained for 48 hours.
Clinical controls were performed I, III, VI months after operation. At the third control (VI month), a new semen analysis was performed, and 65% of patients had an improvement of seminal characteristics. In 394 patients, a complete resolution of varicocele was observed; 4 patients had a recurrence of the pathology and 11 had a recidive. Seventy-three patients who presented a concomitant homolateral inguinal hernia were treated at the same time.
The conclusion is drawn that microsurgical ligation of spermatic veins represents a good surgical option in the treatment of varicocele. It is a quite simple technique that guarantees a low risk of recidives, permits using local or loco-regional anesthesia and can be performed in day-surgery with good results, few complications and good short and long term results.
精索静脉曲张在大约15%的男性人群中被发现，被认为是不育的主要原因。精索静脉曲张的治疗方法包括手术（传统或腹腔镜手术）或保守技术（硬化疗法）。作者介绍了他们在显微外科腹股沟精索静脉高位结扎术方面的经验。自1992年以来采用了这种技术以降低精索静脉高位结扎术后复发的发生率；它还允许使用局部或区域麻醉，减少住院时间并实现微创方法。
1992年至1997年期间，米兰军事医院对409例患有特发性精索静脉曲张的年轻男性进行了433例保留动脉和淋巴管的显微外科腹股沟精索静脉高位结扎术。所有患者术后24小时出院。只有那些住得离医院特别远的患者住院48小时。
术后第1、3、6个月进行临床检查。在第三次检查（第6个月）时，进行了新的精液分析，65%的患者精液特征有所改善。在394例患者中，观察到精索静脉曲张完全消失；4例患者病情复发，11例患者再次复发。73例同时患有同侧腹股沟疝的患者也在同一时间接受了治疗。
得出的结论是，精索静脉显微外科结扎术是治疗精索静脉曲张的一种良好手术选择。这是一种相当简单的技术，保证复发风险低，允许使用局部或区域麻醉，并且可以在日间手术中进行，效果良好，并发症少，短期和长期效果都很好。
