Keene David J B, Cervellione Raimondo M
Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
Department of Paediatric Urology, Royal Manchester Children's Hospital, Manchester, United Kingdom.
J Pediatr Surg. 2014 Feb;49(2):308-11; discussion 311. doi: 10.1016/j.jpedsurg.2013.11.045. Epub 2013 Nov 15.
One of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience.
A prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9 months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range).
Twenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6-15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100-126) minutes.
Intra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature.
精索静脉曲张手术的挑战之一是在确保手术成功的同时预防鞘膜积液形成。亚甲蓝已被用于识别和保留淋巴管，静脉造影一直是硬化疗法和经皮逆行技术的标准组成部分。作者在腹腔镜精索静脉高位结扎术中结合了这两种方法并报告了他们的经验。
对多普勒超声显示有特发性精索静脉曲张和自发性静脉反流的青少年进行了一项前瞻性研究。在建立气腹之前，通过阴囊切口将蔓状静脉丛静脉插管。在荧光透视下将亚甲蓝和欧乃派克™的混合物注入蔓状静脉丛。然后使用5毫米内镜夹或双极血管封闭装置（如等离子动力™或结扎速™）进行腹腔镜选择性静脉结扎。重复静脉造影以确认睾丸内静脉完全结扎。术后3、6和9个月对患者进行临床检查和多普勒超声随访。数据以中位数（四分位间距）表示。
24例患者接受了腹腔镜选择性静脉结扎术并进行了静脉造影和亚甲蓝注射。中位年龄为14.7（14.6 - 15.7）岁。复发率为12%。没有患者出现鞘膜积液。手术时长为120（100 - 126）分钟。
术中静脉注射亚甲蓝和静脉造影有助于识别睾丸内静脉的静脉分支，并提高腹腔镜选择性静脉结扎的成功率。这种方法可预防鞘膜积液形成，但复发率为12%，这似乎高于文献中描述的一些技术。
