Liu R S, Chen Y K, Hsu H S, Chen M T, Shen Y Y, Yeh S H
Department of Nuclear Medicine, Taipei Veterans General Hospital, Taiwan, ROC.
Nucl Med Commun. 1994 Jul;15(7):540-4. doi: 10.1097/00006231-199407000-00008.
Varicocoeles could be classified into stop-type and shunt-type. In stop-type varicocoeles, only the internal spermatic (testicular) vein is dilated and needs to be ligated. In shunt-type, both internal spermatic vein and external spermatic (cremasteric) vein are dilated due to incompetence of the cremasteric system and both venous systems require ligation. Two-phase (flow and static) scrotal scintigraphy was performed on 92 patients preoperatively. Forty-three patients in whom the testicular and cremasteric veins could be verified during operation were included in this study. All 43 patients had unilateral varicocoeles and had abnormal blood pooling in the affected spermatic cord and hemiscrotum. In the blood flow study, 22 of 27 shunt-type varicocoeles had abnormal flow in the spermatic cord whereas only one out of 16 stop-type varicocoeles had increased blood flow. No difference in the results of semen analysis was found between the two groups of patients. Two-phase scrotal scintigraphy provides a noninvasive evaluation of shunting of the retrograde venous flow from the internal spermatic to the external spermatic vein. Understanding this pathophysiological change would be of benefit in the decision making about a surgical approach to varicocoeles.
精索静脉曲张可分为梗阻型和分流型。在梗阻型精索静脉曲张中，仅精索内（睾丸）静脉扩张，需要进行结扎。在分流型中，由于提睾肌系统功能不全，精索内静脉和精索外（提睾肌）静脉均扩张，两个静脉系统均需结扎。对92例患者术前进行了双期（血流期和静态期）阴囊闪烁显像。本研究纳入了43例术中可证实睾丸静脉和提睾肌静脉的患者。所有43例患者均为单侧精索静脉曲张，患侧精索和半侧阴囊有异常血液淤积。在血流研究中，27例分流型精索静脉曲张中有22例精索血流异常，而16例梗阻型精索静脉曲张中只有1例血流增加。两组患者精液分析结果无差异。双期阴囊闪烁显像可对精索内静脉至精索外静脉的逆行静脉血流分流进行无创评估。了解这种病理生理变化将有助于精索静脉曲张手术方式的决策。
