Ciaccio V, Ficola F, Ceccarelli F, Capodicasa E
Istituto di Patologia Speciale Chirurgica, Università degli Studi, Perugia.
Minerva Chir. 1995 May;50(5):469-73.
Varicose veins present a major health problem, causing chronic leg symptoms and disability to a large segment of population. The prevalence rate in adults shows great geographical variations and increases with age. Several authors reported that most cases of primary varicose veins are due to valvular incompetence of saphenofemoral junctions. On the base of close physiopathologic and hemodynamic relationships between primary varicose veins and primary varicocele we decided to evaluate the continence of saphenofemoral junctions in a selected group of young men affected by primary varicocele. MATERIALS AND METHODS. 42 patients were included in the study. The age ranged from 13 to 55 years; the mean age was 28 years. In all cases a clinical and instrumental (ultranosography. Doppler flowmetry) diagnosis of primary varicocele was performed. Bidirectional Doppler flowmetry was used to evaluate the continence of 84 saphenofemoral junctions. RESULTS. Among the group of studied 36 (85.7%) showed a monolateral or bilateral valvular incompetence of saphenofemoral junctions; in the remaining 6 patients (14.3%) there was no evidence of valvular insufficiency. In 84 saphenofemoral junctions studied 52 (61.9%) were found incompetent, 32 to the left side and 20 to the right side. Moreover 2 patients had clinically detectable varicose veins of the lower limbs and symptoms related to chronic venous insufficiency. DISCUSSION. Varicose veins are one of the most prevalent chronic conditions in industrialized countries and places a considerable demand on the health services. Since this pathology is potentially preventable it seems very important to select within populations asymptomatic groups in which there is an increasing risk of chronic venous insufficiency and to perform a clinical and instrumental assessment, based on non invasive techniques. In the past varicose veins were related to other diseases and among them some authors suggested primary varicocele, that is due to venous spermatic reflux and/or valvular incompetence; furthermore varicocele and varicose veins are often familiar. In our 42 patients affected by varicocele only 6 (14.3%) had no Doppler flowmetry evidence of incompetence of saphenofemoral junctions and more than half (61.9%) of the junctions were found incompetent. CONCLUSIONS. In our experience we found a considerable relationship between primary varicocele and venous incompetence of saphenofemoral junctions. Perhaps these patients must be considered a group with an increasing risk to develop primary varicose veins. So we suggest that clinical examination and instrumental assessment should be performed in young men affected by varicocele, in order to obtain a prevention of chronic venous insufficiency of the lower limbs. Nevertheless this retrospective study has to be further confirmed by longterm prospective studies.
静脉曲张是一个主要的健康问题，导致很大一部分人出现慢性腿部症状和残疾。成年人中的患病率在地域上有很大差异，且随年龄增长而增加。几位作者报告称，大多数原发性静脉曲张病例是由于大隐静脉股静脉交界处瓣膜功能不全所致。基于原发性静脉曲张和原发性精索静脉曲张之间密切的生理病理和血流动力学关系，我们决定评估一组患有原发性精索静脉曲张的年轻男性中大隐静脉股静脉交界处的瓣膜功能。材料与方法。42名患者纳入本研究。年龄范围为13至55岁；平均年龄为28岁。所有病例均进行了原发性精索静脉曲张的临床和仪器检查（超声检查、多普勒血流测定）诊断。使用双向多普勒血流测定法评估84个大隐静脉股静脉交界处的瓣膜功能。结果。在研究组中，36例（85.7%）显示大隐静脉股静脉交界处单侧或双侧瓣膜功能不全；其余6例患者（14.3%）未发现瓣膜功能不全的证据。在研究的84个大隐静脉股静脉交界处中，52个（61.9%）被发现功能不全，左侧32个，右侧20个。此外，2例患者有临床可检测到的下肢静脉曲张及与慢性静脉功能不全相关的症状。讨论。静脉曲张是工业化国家最常见的慢性病之一，对医疗服务提出了相当大的需求。由于这种疾病具有潜在的可预防性，在人群中筛选出慢性静脉功能不全风险增加的无症状群体，并基于非侵入性技术进行临床和仪器评估似乎非常重要。过去，静脉曲张与其他疾病有关，其中一些作者提出原发性精索静脉曲张，这是由于精索静脉反流和/或瓣膜功能不全所致；此外，精索静脉曲张和静脉曲张往往具有家族性。在我们的42例精索静脉曲张患者中，只有6例（14.3%）没有多普勒血流测定证据显示大隐静脉股静脉交界处功能不全，且超过一半（61.9%）的交界处被发现功能不全。结论。根据我们的经验，我们发现原发性精索静脉曲张与大隐静脉股静脉交界处静脉功能不全之间存在相当大的关联。也许这些患者必须被视为发生原发性静脉曲张风险增加的群体。因此，我们建议对患有精索静脉曲张的年轻男性进行临床检查和仪器评估，以预防下肢慢性静脉功能不全。然而，这项回顾性研究必须通过长期前瞻性研究进一步证实。
