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小儿精索静脉曲张经皮栓塞治疗的结果:7年回顾性研究

Varicocele percutaneous embolization outcomes in a pediatric group: 7-year retrospective study.

作者信息

Malekzadeh Sonaz, Fraga-Silva Rodrigo A, Morère Pierre-Henri, Sorega Alexandra, Produit Stephan, Stergiopulos Nikolaos, Constantin Christophe

机构信息

Department of Radiology, Sion Hospital, Sion, Switzerland.

Service d'imagerie diagnostique et interventionnelle, Centre Hospitalier du Centre du Valais, Avenue du Grand-Champsec 80, 1950, Sion, Switzerland.

出版信息

Int Urol Nephrol. 2016 Sep;48(9):1395-9. doi: 10.1007/s11255-016-1340-x. Epub 2016 Jun 30.

DOI:10.1007/s11255-016-1340-x
PMID:27363981
Abstract

PURPOSE

Percutaneous embolization and surgical repair are the current treatment options for varicocele, but determining method superiority remains controversial. In this retrospective study, we evaluate the technical success, complication and recurrence rates following percutaneous embolization in a pediatric group, which were compared to reported outcomes for surgical repairs.

METHODS

Thirty children treated for percutaneous varicocele embolization were recruited. The side and grade of varicocele, symptoms, testicular asymmetry, mean recurrence time, total radiation dose and complications were evaluated. Recurrence and follow-up complications due to embolization were also reviewed.

RESULTS

The venography showed retrograde filling of the internal spermatic vein with the identification of aberrantly fed vessels in 23 % of patients. None of the patients suffered from procedure complications except one who had venous injury which was treated with a sclerosing agent. The technical success rate was 93 % (28 patients) with a recurrence rate of 13 % (4 patients). Interestingly, the mean radiation dose used was 862.5 µGy m(2), 3 times lower than abdominal CT.

CONCLUSION

Considering the intravascular nature of embolization, which aims to avoid testicular artery and spermatic cord damage (difficult to avoid with the surgical method), and consequently a lower complication rate, along with the same success rate and recurrence rate, our study supports that embolization is a superior method to surgical interventions.

摘要

目的

经皮栓塞和手术修复是目前治疗精索静脉曲张的方法,但确定哪种方法更具优势仍存在争议。在这项回顾性研究中,我们评估了儿科患者经皮栓塞后的技术成功率、并发症和复发率,并与手术修复的报告结果进行比较。

方法

招募了30名接受经皮精索静脉曲张栓塞治疗的儿童。评估精索静脉曲张的侧别和分级、症状、睾丸不对称情况、平均复发时间、总辐射剂量和并发症。还回顾了栓塞引起的复发和随访并发症。

结果

静脉造影显示精索内静脉逆行充盈,23%的患者发现有异常供血血管。除1例因静脉损伤用硬化剂治疗外,无患者出现手术并发症。技术成功率为93%(28例患者),复发率为13%(4例患者)。有趣的是,使用的平均辐射剂量为862.5µGy m(2),比腹部CT低3倍。

结论

考虑到栓塞的血管内性质,其目的是避免睾丸动脉和精索损伤(手术方法难以避免),因此并发症发生率较低,同时成功率和复发率相同,我们的研究支持栓塞是一种优于手术干预的方法。

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Varicocele surgery or embolization: Which is better?精索静脉曲张手术还是栓塞术:哪种更好?
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Current management principles for adolescent varicocele.青少年精索静脉曲张的当前治疗原则。
精索静脉曲张的超声评估:系统文献回顾及 ESUR-SPIWG 指南和建议的基本原理。
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Best practice in the diagnosis and treatment of varicocele in children and adolescents.儿童和青少年精索静脉曲张诊断与治疗的最佳实践
Ther Adv Urol. 2018 Jun 22;10(9):273-282. doi: 10.1177/1756287218783900. eCollection 2018 Sep.
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Pathological effect of arterial ischaemia and venous congestion on rat testes.动脉缺血和静脉淤血对大鼠睾丸的病理性影响。
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