Bigot J M, Utzmann O
J Urol (Paris). 1983;89(2):121-31.
Full details of the technique employed for right testicular vein phlebography during investigation of male sterility are exposed, and the presence of a varicocele defined among 250 cases explored. Diagnosis of a varicocele is confirmed when there is reflux filling of the pampiniform plexus veins at the scrotal level, the lesion being considered absent when a continent valve prevents any descent of the contrast medium column. Successful catheterization of the right testicular vein was accomplished in 193 cases (66%) of the last 250 bilateral testicular vein phlebographs performed, enabling data concerning the radiological anatomy of this vein to be obtained. In 95%t of cases it emptied into the inferior vena cava and in the other 5% into the renal vein, between L1 and L3, while in 7% the vein emptied into both. Anastomoses are frequent: with the exorenal circle (15 to 18% of cases); the intercostal veins; the lumbar and perivertebral system; the inferior vena cava; the peri-ureteral veins; the testicular vein itself, and finally the portal system through a colic trunk emptying into the inferior mesenteric vein (29% of cases). The frequency and characteristics of right-sided varicocele in patients with male secretory infertility is discussed in relation to findings in these 250 cases. Bilateral phlebography in 187 patients showed normal appearances in 25 cases, bilateral varicoceles in 96, and unilateral varicoceles (including 27 on the right) in 66 cases. Unilateral phlebography in 55 patients revealed the presence of an isolated right-sided varicocele in 4 patients. The question is raised as to the need for phlebography in patients with clinically evident varicoceles, and inversely, the significance of a varicocele demonstrated only on radiology. Physiopathological studies could possibly determine the effect of a varicocele on testicular function. A suggested means of treatment is by embolization of the valvular incontinent venous system.
本文详细介绍了在男性不育症检查过程中进行右侧睾丸静脉造影的技术细节，并阐述了在250例接受检查的病例中精索静脉曲张的存在情况。当阴囊水平的蔓状静脉丛静脉出现反流充盈时，精索静脉曲张的诊断得以确认；当存在一个阻止造影剂柱下降的节制瓣膜时，则认为不存在病变。在最近进行的250例双侧睾丸静脉造影中，193例（66%）成功完成了右侧睾丸静脉的插管，从而获得了有关该静脉放射解剖学的数据。在95%的病例中，该静脉汇入下腔静脉，另外5%在L1和L3之间汇入肾静脉，还有7%的静脉同时汇入两者。吻合情况很常见：与肾外静脉环（15%至18%的病例）；肋间静脉；腰静脉和椎旁静脉系统；下腔静脉；输尿管周围静脉；睾丸静脉本身，最后通过一条排空至肠系膜下静脉的结肠干与门静脉系统相通（29%的病例）。结合这250例病例的研究结果，讨论了男性分泌性不育患者右侧精索静脉曲张的发生率及特征。187例患者的双侧静脉造影显示，25例外观正常，96例双侧精索静脉曲张，66例单侧精索静脉曲张（包括右侧27例）。55例患者的单侧静脉造影显示，4例存在孤立的右侧精索静脉曲张。文章提出了临床上明显精索静脉曲张患者是否需要进行静脉造影的问题，反之，仅在放射学上显示的精索静脉曲张的意义也值得探讨。生理病理学研究可能有助于确定精索静脉曲张对睾丸功能的影响。一种建议的治疗方法是对瓣膜功能不全的静脉系统进行栓塞。
