Kim K S, Lee C, Song S H, Cho S J, Park S, Moon K H, Ryu D S, Park S
Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, 138-736 Seoul, South Korea.
Department of Anesthesiology and Pain Medicine, Cheju National University College of Medicine, Cheju National University Hospital, 690-716, #154, 3-Do 2-Dong, Jeju City, South Korea.
J Pediatr Urol. 2014 Jun;10(3):435-40. doi: 10.1016/j.jpurol.2013.11.003. Epub 2013 Nov 22.
To investigate the effectiveness of laparoscopic varicocelectomy (LV) in adolescents with varicocele and analyze the impact of internal spermatic artery (ISA) preservation on surgical outcomes.
Data on 92 adolescents with left varicocele who underwent LV between December 1998 and January 2011 were retrospectively analyzed. The mean age of the patients was 13.2 ± 2.1 years. Age, grade of disease, number of ligation veins, recurrence rates, and catch-up growth were analyzed in patients who underwent ISA preservation and ligation. The median duration of the follow-up was 21 months.
ISA preservation was performed on 50 patients (54%). There were no significant inter-group differences in terms of age, varicocele grade, number of ligation veins, and catch-up growth (93% vs. 90%). The patients who received artery preservation demonstrated a higher recurrence rate (22%) than those who received artery ligation (5%; p = 0.032). Among 13 patients who had persistent or recurrent varicocele, nine were treated with embolization and one was treated with magnification-assisted subinguinal varicocelectomy. None of these 10 patients demonstrated recurrence or testicular atrophy.
LV with ISA ligation can reduce the recurrence rate and results in the same catch-up growth rate in comparison with LV with ISA preservation.
探讨腹腔镜精索静脉高位结扎术（LV）治疗青少年精索静脉曲张的有效性，并分析保留精索内动脉（ISA）对手术效果的影响。
回顾性分析1998年12月至2011年1月间92例行LV手术的左侧精索静脉曲张青少年患者的数据。患者平均年龄为13.2±2.1岁。对保留和结扎ISA的患者的年龄、疾病分级、结扎静脉数量、复发率及追赶生长情况进行分析。随访时间中位数为21个月。
50例患者（54%）保留了ISA。在年龄、精索静脉曲张分级、结扎静脉数量及追赶生长方面（93%对90%），两组间无显著差异。保留动脉的患者复发率（22%）高于结扎动脉的患者（5%；p=0.032）。在13例持续性或复发性精索静脉曲张患者中，9例接受了栓塞治疗，1例接受了放大辅助腹股沟下精索静脉高位结扎术。这10例患者均未出现复发或睾丸萎缩。
与保留ISA的LV相比，结扎ISA的LV可降低复发率，并具有相同的追赶生长率。
