Sayfan J, Adam Y G
Fertil Steril. 1978 Jun;29(6):669-75. doi: 10.1016/s0015-0282(16)43343-1.
Intraoperative internal spermatic vein phlebography was performed in 20 subfertile patients with a varicocele; 10 patients with varicoceles and left-sided indirect inguinal hernias without fertility problems served as controls. Phlebography was carried out during surgery with the patient supine and in a 45 degree anti-Trendelenburg position to stimulate an "erect" posture. In all 25 patients with a varicocele, valvular insufficiency was demonstrated at the renal-spermatic vein junction. When visualized, the position of the left adrenal vein in all instances was medial to or opposite the renal-internal spermatic vein confluence. This observation, reinforced by simultaneous determinations of cortisol levels in the internal spermatic and antecubital veins, practically excluded the validity of the theory of adrenal hormonal suppression of testicular tissues. In 40% of subfertile patients with a varicocele, double internal spermatic veins and reflux to the distended external spermatic (cremasteric) venous plexus were demonstrated. In no instance were such phenomena observed in the control groups. The not-infrequent failure of operative correction of varicocele seems to relate directly to such overlooked pathology. Broad clinical application of operative phlebography, especially in recurrent, persistent, or clinically advanced cases, will detect such anomalies and should reduce significantly the operative failures in the surgical correction of varicocele.
对20例患有精索静脉曲张的不育患者进行了术中精索内静脉造影；10例患有精索静脉曲张且左侧腹股沟斜疝但无生育问题的患者作为对照。静脉造影在手术过程中进行，患者仰卧，处于45度反特伦德伦伯格体位以模拟“直立”姿势。在所有25例患有精索静脉曲张的患者中，均在肾-精索静脉交界处证实存在瓣膜功能不全。在显影时，所有病例中左肾上腺静脉的位置均在内侧或与肾-精索内静脉汇合处相对。通过同时测定精索内静脉和肘前静脉中的皮质醇水平进一步证实了这一观察结果，这实际上排除了肾上腺激素抑制睾丸组织这一理论的正确性。在40%的患有精索静脉曲张的不育患者中，发现了双精索内静脉以及血液反流至扩张的精索外（提睾肌）静脉丛的情况。在对照组中未观察到此类现象。精索静脉曲张手术矫正时常出现失败似乎与这种被忽视的病理状况直接相关。手术静脉造影的广泛临床应用，尤其是在复发性、持续性或临床进展期病例中，将检测到此类异常情况，并应显著减少精索静脉曲张手术矫正中的手术失败率。
