Colpi Giovanni Maria, Carmignani Luca, Nerva Franco, Piediferro Guido, Castiglioni Fabrizio, Grugnetti Cristina, Galasso Giacomo
University of Milan, Andrology Unit, San Paolo Hospital, Milan, Italy.
BJU Int. 2006 Jan;97(1):142-5. doi: 10.1111/j.1464-410X.2006.05915.x.
To evaluate the efficacy, in terms of recurrences, complications and operative duration, of a new technique for treating varicocele.
Between September 1999 and December 2002 we evaluated 307 men aged 17-51 years with varicocele. In all of the men the clinical diagnosis was confirmed by ultrasonography. The men were treated by a variant of the microsurgical technique described in 1994. A 2-3 cm distal subinguinal incision was made at the level of the superficial inguinal ring and the spermatic cord was exposed. The largest vein in the spermatic cord fat was cannulated. A 7-9 cm segment of the spermatic cord was clamped for 8-10 min; at the start of the ischaemia time, 1.5-3 mL of 3% atoxysclerol was injected into the cannulated vein. After sclerotherapy, the vein was ligated at the injection site, and the blood flow to the cord was restored.
The mean operative duration was 25 min. Follow-up at 3 and 6 months after surgery, with objective examination and scrotal ultrasonography, revealed one case of clinical recurrence/persistence. The most common complication was penile lymphangitis (nine men) that regressed spontaneously; three men had temporary orchialgia. There were no cases of secondary hydrocele or testicular atrophy.
The modified technique appears to be relatively easy and safe, and to of low cost. Given the promising results in terms of complications and persistence, the treatment appears to be a suitable first-line approach for the surgical treatment of varicocele.
从复发率、并发症及手术时长方面评估一种治疗精索静脉曲张的新技术的疗效。
1999年9月至2002年12月期间，我们对307名年龄在17至51岁的精索静脉曲张男性患者进行了评估。所有患者的临床诊断均经超声检查确诊。这些患者接受了1994年描述的显微外科技术的一种变体治疗。在腹股沟浅环水平做一个2 - 3厘米的腹股沟下远端切口，暴露精索。将精索脂肪中最大的静脉插管。将精索的一段7 - 9厘米长的部分夹闭8 - 10分钟；在缺血时间开始时，向插管的静脉内注入1.5 - 3毫升3%的十四烷基硫酸钠。硬化治疗后，在注射部位结扎静脉，恢复精索的血流。
平均手术时长为25分钟。术后3个月和6个月进行随访，通过客观检查和阴囊超声检查发现1例临床复发/持续存在。最常见的并发症是阴茎淋巴管炎（9名男性），可自行消退；3名男性有暂时性睾丸疼痛。没有继发性鞘膜积液或睾丸萎缩的病例。
改良技术似乎相对简单、安全且成本低。鉴于在并发症和复发方面的良好结果，该治疗似乎是精索静脉曲张手术治疗的一种合适的一线方法。
