Chouchane A, Menif A, Elkateb A F, Becheikh M, Zenkri M, Balti M H
Service de chirurgie, Hôpital des FSI, La Marsa.
Tunis Med. 2001 Apr;79(4):216-21.
Varicocele is a frequent and benign pathology, well known since the antiquity, his treatment has progressed by a better acquaintance of physiology and the effects on fertility. In the surgery department of FSI hospital, we compared the results of 2 surgical methods: the Ivanisevich's technique (open surgery) and the laparoscopic approach. The objective was to compare morbidity, recurrence rate, hospital stay, and effects on pains and fertility. From May 1993 to December 1998 we treated 72 patients with symptomatic varicocele: 40 patients by laparoscopy and 32 by open surgery. The recurrence rate was of 32% for surgery and 21% for laparoscopy. But duration of surgical operation was longer for laparoscopy: 50 mn against 30 mn for unilateral cure and 70 mn against 55 mn for bilateral cure. We did not observe a difference between the 2 groups in hospital stay, morbidity, pains and fertility. At the end of the study we propose laparoscopy for bilateral cure and open surgery for unilateral. Decrease of recurrences needs the realisation of a phlebography before surgery, but this investigation weight routinely "take charge" of patients; we reserve it to recurrences. Echography coupled to Doppler is essentially used for preoperative diagnosis of varicocele and for surveillance of postoperative recurrences.
精索静脉曲张是一种常见的良性病变，自古以来就为人所知，随着对生理学以及对生育能力影响的进一步了解，其治疗方法也有了进展。在FSI医院外科，我们比较了两种手术方法的结果：伊万尼塞维奇技术（开放手术）和腹腔镜手术。目的是比较发病率、复发率、住院时间以及对疼痛和生育能力的影响。从1993年5月至1998年12月，我们治疗了72例有症状的精索静脉曲张患者：40例行腹腔镜手术，32例行开放手术。开放手术的复发率为32%，腹腔镜手术为21%。但腹腔镜手术的手术时间更长：单侧治愈为50分钟，而开放手术为30分钟；双侧治愈为70分钟，开放手术为55分钟。我们未观察到两组在住院时间、发病率、疼痛和生育能力方面存在差异。在研究结束时，我们建议双侧治愈采用腹腔镜手术，单侧采用开放手术。降低复发率需要在手术前进行静脉造影，但这项检查通常会增加患者的负担；我们仅将其用于复发病例。超声结合多普勒主要用于精索静脉曲张的术前诊断和术后复发监测。
