Piñera J Gonzálvez, Fernández-Córdoba M S, Anselmi E Hernández, Mollá E Juliá, Jiménez M J Pedrosa, Cabañero A G Blanco, Baró A Palma
Servicio de Cirugía Pediátrica, Complejo Hospitalario Universitario de Albacete, Albacete.
Cir Pediatr. 2009 Jul;22(3):128-33.
There is evidence that early varicocele treatment decreases testicular damage. The minimally invasive techniques such as laparoscopic varicocelectomy, antegrade sclerotherapy and percutaneous retrograde embolisation, are acquiring greater significance in the treatment of this disease. Since 1994, a series of 51 children, aged 7-16 years (mean, 12.9 years), with left-sided varicocele grades 2 (47%) and 3 (53%) were treated in our institution by percutaneous retrograde embolisation using coils. The right basilica vein was the most widely used (70%) followed by the right femoral vein. Seven children (13.7%) had complications: perforation of internal spermatic vein was the most frequent and treated conservatively. No child presented hydrocele after radiological procedures. Embolisation was accomplished succesfully at the first attempt in 35 (68.6%) of the 51 children and in 45 (88.2%) after a second embolisation. The follow-up ranges from 7 months to 5 ? years (mean, 1.8 years). The patients were monitored with clinical and doppler ultrasound examination 3, 6 and 12 months after the treatment. Retrograde embolisation is a safe and efficient minimally invasive treatment for correcting varicoceles in children. We performed retrograde embolisation as first choice of varicocele treatment in children; a second embolisation or conventional surgery for primary failure or late recurrence should be considered.
有证据表明早期精索静脉曲张治疗可减少睾丸损伤。诸如腹腔镜下精索静脉高位结扎术、顺行硬化疗法和经皮逆行栓塞术等微创技术在该疾病的治疗中正变得越来越重要。自1994年以来,我们机构对51名年龄在7至16岁(平均12.9岁)的左侧精索静脉曲张2级(47%)和3级(53%)患儿采用弹簧圈经皮逆行栓塞术进行治疗。最常使用的是右侧贵要静脉(70%),其次是右侧股静脉。7名患儿(13.7%)出现并发症:精索内静脉穿孔最为常见,采用保守治疗。在放射学检查后没有患儿出现鞘膜积液。51名患儿中有35名(68.6%)在首次尝试时成功完成栓塞,在第二次栓塞后有45名(88.2%)成功完成栓塞。随访时间为7个月至5年(平均1.8年)。在治疗后3、6和12个月对患者进行临床和多普勒超声检查监测。逆行栓塞术是一种安全有效的微创治疗方法,用于矫正儿童精索静脉曲张。我们将逆行栓塞术作为儿童精索静脉曲张治疗的首选方法;对于初次治疗失败或晚期复发的情况,应考虑进行第二次栓塞或传统手术。