Belloli G, D'Agostino S, Musi L, Campobasso P
Division of Pediatric Surgery, Regional Hospital, Vicenza, Italy.
Eur J Pediatr Surg. 1995 Aug;5(4):219-21. doi: 10.1055/s-2008-1066209.
Conventional varicocelectomy is often complicated by high recurrence rate, ranging from 6 to 25% and the persistence usually is due to residual venous communications. We report our experience of 21 years in varicocele correction using 3 different operative techniques on 389 adolescents. In the first 12 years (120 patients) a typical ivanissevich operation was carried out with a recurrence rate of 18%. In the following 4 years (63 patients) a preoperative venography was always carried out and a surgical procedure via an inguinal approach was performed with high retroperitoneal and inguinal ligations of the internal spermatic vein(s) and cremasteric vein(s) as indicated by venography; the recurrence rate was still 8%. In the last 5 years we have been using a personally modified technique characterized by: 1) unique access to all venous areas both in the retroperitoneum and in the inguinal canal with a systematic ligation of the internal and external spermatic veins and the deferential vein when dilated; 2) intraoperative identification of the residual collaterals after venous ligations by injecting some milliliters of a blue-methylene solution. This procedure allowed a varicocele recurrence in only 2 out of 206 consecutive patients (1%). Our results suggest that it may be possible to lessen significantly the postoperative recurrence rate using some simple operative tricks.
传统的精索静脉曲张切除术常因复发率高而复杂化，复发率在6%至25%之间，复发通常是由于残留的静脉交通支所致。我们报告了21年来对389名青少年采用3种不同手术技术进行精索静脉曲张矫正的经验。在最初的12年（120例患者）中，实施了典型的伊瓦尼塞维奇手术，复发率为18%。在接下来的4年（63例患者）中，总是进行术前静脉造影，并根据静脉造影结果通过腹股沟入路进行手术，对精索内静脉和提睾肌静脉进行高位腹膜后和腹股沟结扎；复发率仍为8%。在过去的5年里，我们一直在使用一种个人改良技术，其特点是：1）通过系统结扎精索内、外静脉以及扩张时的输精管静脉，独特地进入腹膜后和腹股沟管的所有静脉区域；2）在静脉结扎后，通过注射几毫升亚甲蓝溶液在术中识别残留的侧支循环。在连续206例患者中，只有2例（1%）出现精索静脉曲张复发。我们的结果表明，使用一些简单的手术技巧可能会显著降低术后复发率。
