Deptartment of Urology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea.
Yonsei Med J. 2012 Jul 1;53(4):723-8. doi: 10.3349/ymj.2012.53.4.723.
To investigate the causes of varicocele recurrence and assess the use of embolization and subinguinal varicocelectomy in its treatment in patients with angiography and subinguinal varicocelectomy.
The present study involved 15 patients with recurrent varicoceles. The mean patient age was 21.2 years (range: 12-42 years). Preoperative angiography was performed in 11 patients. Embolization was used in patients with patent internal spermatic veins (ISVs). Patients without patent ISVs or preoperative angiography underwent magnification-assisted subinguinal varicocelectomy which included testicular retrieval and ligation of all collateral veins except arteries and deferential veins.
Seven among 11 patients (64%) which had preoperative angiography had patent ISVs and underwent embolization and 8 patients underwent subinguinal varicocelectomy. Of those 8 patients, 6 had dilated ISVs and external spermatic veins (ESVs), one had dilated ISVs and gubernacular veins, and one had dilated ISVs, ESVs and gubernacular veins. No patient experienced recurrence or testis atrophy.
Patent ISVs or collateral veins may be the cause of recurrence after varicocelectomy. Angiographic embolization was successful in 64% of recurrent varicoceles patients with patent ISVs. However, microscope-assisted subinguinal varicocelectomy may be the best overall treatment for patients with recurrent varicoceles.
探讨精索静脉曲张复发的原因，并评估血管造影和精索内静脉结扎术后栓塞和精索下静脉结扎术在其治疗中的应用。
本研究共纳入 15 例精索静脉曲张复发患者。患者平均年龄为 21.2 岁（范围：12-42 岁）。11 例患者术前进行了血管造影。对于有通畅精索内静脉（ISV）的患者采用栓塞治疗。对于没有通畅 ISV 或未行术前血管造影的患者，行放大辅助精索下静脉结扎术，包括睾丸取出和结扎所有除动脉和精索静脉外的侧支静脉。
11 例患者中有 7 例（64%）术前血管造影显示 ISV 通畅，并进行了栓塞治疗，8 例患者行精索下静脉结扎术。这 8 例患者中，6 例 ISV 和精索外静脉（ESV）扩张，1 例 ISV 和精索内筋膜静脉扩张，1 例 ISV、ESV 和精索内筋膜静脉扩张。无患者出现复发或睾丸萎缩。
通畅的 ISV 或侧支静脉可能是精索静脉结扎术后复发的原因。血管造影栓塞术对有通畅 ISV 的复发性精索静脉曲张患者成功率为 64%。然而，显微镜辅助精索下静脉结扎术可能是治疗复发性精索静脉曲张的最佳方法。
