Division of Urology, Montreal Children's Hospital, McGill University Health Center, Montréal, QC, Canada.
J Pediatr Urol. 2013 Feb;9(1):33-7. doi: 10.1016/j.jpurol.2011.11.004. Epub 2011 Dec 1.
The ideal method for varicocelectomy in children remains controversial. We present our experience with dye-assisted lymphatic-sparing laparoscopic varicocelectomy (LSLV) in children, which overcomes the limitations of previously described techniques.
Twenty-five consecutive LSLVs were performed on children with a mean age of 15 years over a 4-year period. Varicocele grade was 3 in 21 cases and grade 2 in 4. Indications for intervention were hypotrophy in 12, pain in 11 cases and family preference in 2. A scrotal injection of lymphatic dye was utilized to spare at least one lymphatic and the remaining spermatic vessels were divided.
Lymphatic sparing was accomplished in all cases. Operative time varied from 30 to 140 min (mean 85 ± 26). No perioperative complications were noted. On average follow-up of 13 months a residual varicocele was noted in 2 cases, with no hydrocele and resolution of pain. Mean testicular volume difference diminished from 33% pre to 18% postoperatively.
This multi-surgeon experience demonstrates that dye-assisted LSLV is easily accomplished with promising results. It appears that preservation of a single spermatic lymphatic vessel is sufficient, although in some cases a second dye injection is required to visualize the lymphatics.
儿童精索静脉曲张手术的理想方法仍存在争议。我们介绍了我们在儿童中使用染料辅助保留淋巴管的腹腔镜精索静脉曲张手术（LSLV）的经验，该方法克服了以前描述的技术的局限性。
在 4 年的时间里，对 25 例平均年龄为 15 岁的儿童进行了连续 25 例 LSLV。21 例精索静脉曲张程度为 3 级，4 例为 2 级。干预的指征是 12 例萎缩，11 例疼痛和 2 例家族偏好。在阴囊内注射淋巴染料以至少保留一条淋巴管，并将其余精索血管分开。
所有病例均成功保留淋巴管。手术时间从 30 分钟到 140 分钟不等（平均 85 ± 26 分钟）。没有围手术期并发症。平均 13 个月的随访发现 2 例残留精索静脉曲张，无鞘膜积液和疼痛缓解。睾丸体积差异平均值从术前的 33%减少到术后的 18%。
多位外科医生的经验表明，染料辅助的 LSLV 很容易完成，并且结果有希望。似乎保留单个精索淋巴管就足够了，尽管在某些情况下需要第二次染料注射以可视化淋巴管。
