Kuenkel M R, Korth K
Department of Urology, Loretto Hospital, Freiburg, Germany.
Eur Urol. 1995;27(1):13-7. doi: 10.1159/000475115.
Clipping of the testicular veins in varicocele in principle follows open surgical treatment modalities such as the Palomo and Bernardi operations by disrupting venous reflux of the testicular veins. Thus, success rates of laparoscopic varicocelectomy range around 85% as well. As a less invasive means of treatment, retrograde (interventional) sclerotherapy of varicocele has produced long-term results as favorable as those of open surgical procedures. Antegrade sclerotherapy was introduced by Tauber as an equivalent, but even less invasive treatment modality, done by the urologist. We have performed antegrade sclerotherapy in more than 80 patients with left-sided primary varicocele. The procedure was done in local anesthesia via a scrotal incision and lasted between 12 and 60 min. If different treatment modalities yield similar long-term results, they must be valued according to how these outcomes are achieved. With antegrade sclerotherapy, the urologist has a modality at hand that is not only less invasive than laparoscopic varicocelectomy, but bears fewer risks for the patient, requires less personnel and costs less. Therefore, we consider laparoscopic varicocelectomy indicated only if antegrade sclerotherapy cannot be performed or has been tried twice without success. However, it may still be considered in bilateral varicoceles.
精索静脉曲张的睾丸静脉结扎原则上遵循开放式手术治疗方式，如帕洛莫手术和贝尔纳迪手术，通过阻断睾丸静脉的静脉回流来进行。因此，腹腔镜精索静脉结扎术的成功率也在85%左右。作为一种侵入性较小的治疗方法，精索静脉曲张的逆行（介入）硬化疗法产生的长期效果与开放式手术相当。顺行硬化疗法由陶伯提出，作为一种等效但侵入性更小的治疗方式，由泌尿科医生进行操作。我们已经对80多名左侧原发性精索静脉曲张患者进行了顺行硬化疗法。该手术在局部麻醉下通过阴囊切口进行，持续时间为12至60分钟。如果不同的治疗方式产生相似的长期效果，那么必须根据实现这些效果的方式来评估它们的价值。采用顺行硬化疗法时，泌尿科医生掌握了一种不仅比腹腔镜精索静脉结扎术侵入性更小，而且对患者风险更低、所需人员更少且成本更低的治疗方式。因此，我们认为只有在无法进行顺行硬化疗法或尝试两次均未成功的情况下，才考虑进行腹腔镜精索静脉结扎术。不过，双侧精索静脉曲张仍可考虑采用该方法。
