Zaupa Paola, Mayr Johannes, Höllwarth Michael E
Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
BJU Int. 2006 Apr;97(4):809-12. doi: 10.1111/j.1464-410X.2006.06033.x.
To evaluate the effectiveness and limitations of antegrade sclerotherapy (AS) for the treatment of primary varicocele in childhood.
From December 1996 to December 2004, 88 patients (mean age 13.3 years, range 9-18) with primary varicocele underwent AS (91 varicocele ablations in all). The indications for surgery were testicular pain (16 boys, 18%), a large varicocele with cosmetic implications, testicular hypotrophy (one) and in 71 (81%) the varicocele was detected incidentally during a routine physical examination; all were left-sided. According to the classification used by Tauber, 46 (52%) varicoceles were grade II and 42 (48%) grade III. The clinical and ultrasonography (US) results were evaluated over a median (range) follow-up of 11 (3-60) months, and the operative duration, X-ray exposure time, persistence rate of varicoceles and complications were compared with those using other techniques.
In 11 patients there was a palpable difference in size between the testicles, but in only five (6%) was testicular hypotrophy (testicular volume (<75% testicular volume vs the normal side) confirmed by US. The mean (sem) operative duration for AS was 33.2 (2.14) min. In 16 (18%) patients it was necessary to expose a second or third vein because the first vein chosen was unsuitable for sclerotherapy. The mean operative radiation exposure was 2.18 (0.21) s. One patient (1%) was treated with a high ligature of the testicular vein (Palomo procedure) after initial unsuccessful AS, and was excluded from the analysis. Eighty-four (97%) patients were eligible for follow-up: six (7%) had a persistent varicocele (four grade II, two grade III), four of whom had repeat sclerotherapy successfully (no recurrence at follow-up). Fourteen (15%) patients had enlarged testicular veins only on US (varicocele grade 0). No patient developed a hydrocele after AS, There were complications after surgery in three (3%) patients (two superficial wound infections, one scrotal haematoma together with focal testicular necrosis).
AS is an efficient minimally invasive surgical method for correcting varicoceles in older children, although the operative duration is sometimes longer than in adults, and surgery can be more difficult because of the smaller veins. Partial testicular necrosis, despite correct AS, is a very rare but serious complication.
评估顺行硬化疗法（AS）治疗儿童原发性精索静脉曲张的有效性及局限性。
1996年12月至2004年12月，88例原发性精索静脉曲张患者（平均年龄13.3岁，范围9 - 18岁）接受了AS治疗（共进行91次精索静脉曲张消融术）。手术指征为睾丸疼痛（16例男孩，18%）、对外观有影响的大精索静脉曲张、睾丸萎缩（1例），71例（81%）在常规体检时偶然发现精索静脉曲张；均为左侧。根据Tauber分类法，46例（52%）精索静脉曲张为II级，42例（48%）为III级。在中位（范围）11（3 - 60）个月的随访期内评估临床及超声（US）结果，并将手术时间、X线暴露时间、精索静脉曲张持续率及并发症与使用其他技术的情况进行比较。
11例患者双侧睾丸大小有可触及的差异，但仅5例（6%）经超声证实存在睾丸萎缩（患侧睾丸体积<正常侧睾丸体积的75%）。AS的平均（标准误）手术时间为33.2（2.14）分钟。16例（18%）患者因所选的第一支静脉不适合硬化治疗而需暴露第二支或第三支静脉。平均手术辐射暴露时间为2.18（0.21）秒。1例患者（1%）在初次AS治疗失败后接受了睾丸静脉高位结扎术（Palomo手术），并被排除在分析之外。84例（97%）患者符合随访条件：6例（7%）存在持续性精索静脉曲张（4例II级，2例III级），其中4例成功接受了重复硬化治疗（随访时无复发）。14例（15%）患者仅超声显示睾丸静脉增粗（精索静脉曲张0级）。AS治疗后无患者发生鞘膜积液。3例（3%）患者术后出现并发症（2例浅表伤口感染，1例阴囊血肿合并局灶性睾丸坏死）。
AS是一种治疗大龄儿童精索静脉曲张的有效微创外科方法，尽管手术时间有时比成人长，且由于静脉较细手术可能更困难。尽管AS操作正确，但部分睾丸坏死是一种非常罕见但严重的并发症。
