Camoglio F S, Cervellione R M, Bruno C, Dipaola G, Chironi C, Corroppolo M, Procacci C, Ottolenghi A
Paediatric Surgery Unit, G.B. Rossi University Hospital, Verona, Italy.
Eur J Pediatr Surg. 2003 Aug;13(4):256-9. doi: 10.1055/s-2003-42232.
To demonstrate the long-term patency of microsurgical anastomoses between the internal spermatic vein and the inferior epigastric vein, constructed in the treatment of essential varicocele in paediatric patients to supplement ligation of the spermatic veins.
We submitted 66 patients to inguinopelvic colour-flow Doppler ultrasonography. The patients had been treated 18 - 36 months earlier for essential varicocele by microsurgical inguinal ligation of the testicular venous pedicle and anastomosis between the internal spermatic vein and the inferior epigastric vein.
Preoperatively, the 66 patients operated on at ages ranging from 10 to 16 years (13 +/- 1.4) presented with Dubin and Amelar grade II (14 patients) or grade III (52 patients) left varicocele with ipsilateral testicular hypotrophy. The postoperative follow-up showed 2 cases of persistence of disease and 3 cases of persistence of "medium" spermatic vein reflux without clinical evidence of varicocele. Seven patients developed left hydrocele which resolved spontaneously in 5 cases, whereas in 2 cases it proved necessary to perform an eversion of the tunica vaginalis of the testis. The results obtained in patients treated for Coolsaet type I varicocele (64 patients) were as follows: long-term patency of the anastomosis was observed in 58/64 patients (90.6 %); in 4 patients (6.2 %) the left inferior epigastric vein presented a position in relation to the homologous artery that prevented adequate sampling and thus made it impossible to assess the patency of the anastomosis; in 2 patients (3.1 %) the anastomosis was closed. In the two patients who had submitted to anastomosis for Coolsaet type III varicocele, colour-flow Doppler failed to identify the shunt.
The results of this study demonstrate that microsurgical anastomosis between the internal spermatic vein, and the inferior epigastric vein remains competent in the long term, thus confirming the validity of this technique for the treatment of essential varicocele in children.
证明在小儿原发性精索静脉曲张治疗中构建的精索内静脉与腹壁下静脉之间显微外科吻合的长期通畅性，以补充精索静脉结扎术。
我们对66例患者进行了腹股沟盆腔彩色多普勒超声检查。这些患者在18至36个月前接受了原发性精索静脉曲张的治疗，采用显微外科腹股沟睾丸静脉蒂结扎术以及精索内静脉与腹壁下静脉吻合术。
术前，这66例年龄在10至16岁（13±1.4岁）的手术患者表现为杜宾和阿梅拉尔二级（14例患者）或三级（52例患者）左侧精索静脉曲张，伴有同侧睾丸萎缩。术后随访显示，有2例疾病持续存在，3例存在“中度”精索静脉反流但无精索静脉曲张的临床证据。7例患者出现左侧鞘膜积液，其中5例自行消退，而在2例中，有必要进行睾丸鞘膜翻转术。治疗库尔萨特I型精索静脉曲张的患者（64例）所获得的结果如下：58/64例患者（90.6%）观察到吻合口长期通畅；4例患者（6.2%）的腹壁下静脉与同源动脉的位置关系妨碍了充分取样，因此无法评估吻合口的通畅性；2例患者（3.1%）吻合口闭合。在接受库尔萨特III型精索静脉曲张吻合术的2例患者中，彩色多普勒未能识别分流。
本研究结果表明，精索内静脉与腹壁下静脉之间的显微外科吻合长期保持通畅，从而证实了该技术在治疗儿童原发性精索静脉曲张方面的有效性。
