Bechara Carlos F, Weakley Sarah M, Kougias Panagiotis, Athamneh Husam, Duffy Patrick, Khera Mohit, Kobayashi Katsuhiro, Lin Peter H
Division of Vascular Surgery and Endovascular Therapy, Michael E, DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Vascular. 2009 Nov-Dec;17 Suppl 3:S129-36. doi: 10.2310/6670.2009.00062.
Successful treatment of a testicular varicocele, which can result in scrotal pain and swelling as well as male subfertility, can be accomplished via operative ligation of the varicocele or interventional treatment with coil embolization of the testicular vein. This study compared the treatment outcome of percutaneous embolization treatment versus laparoscopic varicocelectomy in patients with symptomatic varicoceles. Patients with varicoceles undergoing either laparoscopic varicocelectomy or percutaneous coil embolization of the testicular vein during a recent 5-year period were analyzed. Treatment outcome and hospital costs of these two minimally invasive treatment modalities were compared. Forty-one patients underwent percutaneous coil embolization of the testicular vein, which were compared with a cohort of 43 patients who underwent laparoscopic varicocelectomy. Technical success in interventional and laparoscopic treatment was 95% and 100%, respectively. The mean operative time or procedural time was 63 +/- 13 minutes and 52 +/- 25 minutes for interventional and laparoscopic cohorts (not significant), respectively. Embolization treatment resulted in two recurrent varicoceles (4.8%) compared to one patient following laparoscopic repair (2.3%, not significant). Embolization treatment was associated with a lower complication rate than laparoscopic repair (9.7% vs 16.3%, p = .03). Regarding cost analysis, no significant difference in hospital cost was noted between the interventional or laparoscopic treatment strategies. Both laparoscopic varicocelectomy and coil embolization are effective treatment modalities for varicoceles. With lower treatment complication rates in the interventional treatment group, coil embolization of the testicular vein offers treatment advantage compared with laparoscopic repair in patients with varicoceles.
睾丸静脉曲张可导致阴囊疼痛、肿胀以及男性不育，成功治疗该疾病可通过对静脉曲张进行手术结扎或采用睾丸静脉线圈栓塞介入治疗来实现。本研究比较了有症状的精索静脉曲张患者经皮栓塞治疗与腹腔镜下精索静脉高位结扎术的治疗效果。分析了在最近5年期间接受腹腔镜下精索静脉高位结扎术或经皮睾丸静脉线圈栓塞术的精索静脉曲张患者。比较了这两种微创治疗方式的治疗效果和住院费用。41例患者接受了经皮睾丸静脉线圈栓塞术，并与43例行腹腔镜下精索静脉高位结扎术的患者进行比较。介入治疗和腹腔镜治疗的技术成功率分别为95%和100%。介入治疗组和腹腔镜治疗组的平均手术时间或操作时间分别为63±13分钟和52±25分钟（无显著差异）。栓塞治疗导致2例精索静脉曲张复发（4.8%），而腹腔镜修复术后有1例复发（2.3%，无显著差异）。栓塞治疗的并发症发生率低于腹腔镜修复术（9.7%对16.3%，p = 0.03）。在成本分析方面，介入治疗或腹腔镜治疗策略的住院费用无显著差异。腹腔镜下精索静脉高位结扎术和线圈栓塞术都是治疗精索静脉曲张的有效方法。介入治疗组的治疗并发症发生率较低，与腹腔镜修复术相比，睾丸静脉线圈栓塞术在精索静脉曲张患者中具有治疗优势。
