Gorenstein A, Katz S, Schiller M
Department of Pediatric Surgery, Hadassah University Hospital, Jerusalem, Israel.
Isr J Med Sci. 1988 Mar;24(3):172-4.
Fifty boys aged 6 to 14 years underwent surgery for left varicocele. Thirty-four patients underwent preoperative retrograde left renal venography and pressure measurements of both renal veins and inferior vena cava. In all patients an intraoperative antegrade renal venography was performed via the internal spermatic vein. The preoperative venographic studies revealed renospermatic reflux in all patients examined. The intraoperative studies demonstrated impaired renal venous drainage in 38 patients (Group A) and normal venous return in 12 patients (Group B). Manometric studies revealed increased left renal venous pressure in Group A. In view of these anatomical and functional disorders, our preferred procedure is a retroperitoneal ligation and excision of the left internal spermatic vein. The retroperitoneum was thoroughly explored and all the visible collaterals of the internal spermatic vein ligated. Forty boys were followed for 1 to 5 years; the varicocele was completely resolved in 35 of them. Five patients had recurrent varicocele; recurrence was observed only in patients with increased left renal vein pressure (Group A).
50名6至14岁的男孩接受了左侧精索静脉曲张手术。34例患者术前行左侧逆行肾静脉造影及双侧肾静脉和下腔静脉压力测量。所有患者均在术中通过精索内静脉进行顺行肾静脉造影。术前静脉造影研究显示，所有接受检查的患者均存在肾精索反流。术中研究表明，38例患者（A组）肾静脉引流受损，12例患者（B组）静脉回流正常。压力测量研究显示A组左肾静脉压力升高。鉴于这些解剖和功能障碍，我们首选的手术方法是腹膜后结扎并切除左侧精索内静脉。彻底探查腹膜后间隙，结扎精索内静脉所有可见的侧支。40名男孩随访1至5年；其中35例精索静脉曲张完全消失。5例患者出现精索静脉曲张复发；仅在左肾静脉压力升高的患者（A组）中观察到复发。
