Cimador M, Pensabene M, Sergio M, Caruso A M, De Grazia E
Department for Mother & Child Care, Pediatric Urology, Università di Palermo, Palermo, Italy.
Int J Androl. 2012 Oct;35(5):700-5. doi: 10.1111/j.1365-2605.2012.01283.x. Epub 2012 Jun 19.
The aim of this study was to report our long-term diagnostic and surgical outcome during the last 18 years, in paediatric and adolescent management of varicocoele. The present retrospective study enrols 374 patients observed at our institution between 1994 and 2011. Patients were divided into three groups: Group A includes 142 youngsters and adolescents treated with open surgery for left varicocoele, in which a pre-operative CDUS was not performed; Group B includes 65 patients treated with open surgery in which a pre-operative CDUS evaluation was carried out, to assess varicocoele haemodynamic pattern and testicular volume. Group C includes 167 patients treated by laparoscopy and with pre-operative CDUS assessment. For all groups post-operative follow-up consisted of CDUS evaluation performed 1, 3, 6, 12 months after surgical treatment, than every year. Persistence/recurrence of varicocoele, testicular volume and presence of hydrocele were evaluated. Recurrence rate was significatively higher in group A (11.2%) than B (no recurrence, p = 0.003) or C (no recurrence, p = 0.000). Post-operative hydrocele was not significantly observed overall in group A in 9.8% of cases (13% if tunica vaginalis was left untouched, 4.2% if everted or resected p = 0.005), in group B in 3% and in group C in 7.1% of cases (p = NS). In conclusion, open and laparoscopic surgery offers similar results. In our opinion, the key-point in paediatric and adolescent varicocoele is not the surgical approach to use, but the exact diagnosis. Careful CDUS evaluation is, in our opinion, a valid, safe, cost-effective and immediate tool to accurately detect all refluxing venous system and for achieving a comprehensive evaluation of the vascular anatomy of varicocoele in paediatric and adolescent age. Laparoscopic Palomo or open subinguinal microsurgical varicocelectomy offer similar results in terms of recurrence; meanwhile the use of a lymphatic sparing surgery with or without blue-dye is recommended to reduce post-operative hydroceles.
本研究的目的是报告我们在过去18年中对小儿和青少年精索静脉曲张进行诊断和手术的长期结果。本回顾性研究纳入了1994年至2011年间在我们机构观察到的374例患者。患者分为三组：A组包括142例接受开放手术治疗左侧精索静脉曲张的青少年，术前未进行彩色多普勒超声（CDUS）检查；B组包括65例接受开放手术治疗的患者，术前进行了CDUS评估，以评估精索静脉曲张的血流动力学模式和睾丸体积；C组包括167例接受腹腔镜手术且术前进行了CDUS评估的患者。所有组术后随访包括在手术治疗后1、3、6、12个月进行CDUS评估，之后每年评估一次。评估精索静脉曲张的持续/复发情况、睾丸体积和鞘膜积液的存在情况。A组的复发率（11.2%）显著高于B组（无复发，p = 0.003）或C组（无复发，p = 0.000）。A组总体上9.8%的病例术后出现鞘膜积液（如果未触动鞘膜，则为13%；如果翻转或切除，则为4.2%，p = 0.005），B组为3%，C组为7.1%（p = 无显著性差异）。总之，开放手术和腹腔镜手术效果相似。我们认为，小儿和青少年精索静脉曲张的关键不在于采用何种手术方式，而在于准确诊断。我们认为，仔细的CDUS评估是一种有效、安全、经济高效且即时的工具，可准确检测所有反流静脉系统，并全面评估小儿和青少年精索静脉曲张的血管解剖结构。腹腔镜Palomo手术或开放腹股沟下显微精索静脉结扎术在复发方面效果相似；同时，建议采用保留淋巴管的手术，无论是否使用蓝色染料，以减少术后鞘膜积液。
