Ghanem H, Anis T, El-Nashar A, Shamloul R
Department of Andrology, Cairo University Faculty of Medicine, Cairo, Egypt.
Urology. 2004 Nov;64(5):1005-9. doi: 10.1016/j.urology.2004.06.060.
To compare and assess objectively the postoperative outcome parameters of both microsurgical subinguinal artery sparing and retroperitoneal high ligation techniques for varicocele in infertile men.
We performed a prospective study that included 413 consecutive patients who presented with varicocele. Of the 413 patients, 304 underwent subinguinal varicocelectomy (group 1) and 109 patients underwent high ligation varicocelectomy (group 2). Subinguinal varicocelectomies were performed under local anesthesia, with intravenous propofol sedation administered as needed. The operating microscope (x10 to x16) was used to spare the arteries and lymphatics. High ligation was performed through a retroperitoneal approach.
All patients went home on the evening after surgery with minimal discomfort. No intraoperative complications occurred. The internal spermatic artery was identified in all microvaricocelectomy cases. No testicular atrophy occurred in either group. Five (1.6%) and seven (6.4%) hydroceles were identified at the 3-month postoperative visit in groups 1 and 2, respectively.
Microvaricocelectomy is safe and effective and associated with a rapid recovery and minimal morbidity. However, it requires microsurgical training.
客观比较和评估显微外科腹股沟下动脉保留术和腹膜后高位结扎术治疗不育男性精索静脉曲张的术后结局参数。
我们进行了一项前瞻性研究，纳入了413例连续的精索静脉曲张患者。在这413例患者中，304例行腹股沟下精索静脉结扎术（第1组），109例行高位结扎精索静脉结扎术（第2组）。腹股沟下精索静脉结扎术在局部麻醉下进行，必要时静脉注射丙泊酚镇静。使用手术显微镜（放大倍数为10至16倍）保留动脉和淋巴管。高位结扎通过腹膜后途径进行。
所有患者术后当晚回家，不适轻微。未发生术中并发症。在所有显微精索静脉结扎术病例中均识别出精索内动脉。两组均未发生睾丸萎缩。在术后3个月的随访中，第1组和第2组分别发现5例（1.6%）和7例（6.4%）鞘膜积液。
显微精索静脉结扎术安全有效，恢复快，发病率低。然而，它需要显微外科培训。
