Musi L, Colombo B, Belloli G
Divisione di Chirurgia Pediatrica, Ospedale Regionale di Vicenza, Italia.
Pediatr Med Chir. 1996 Sep-Oct;18(5 Suppl):31-4.
A varicocele first develops in early adolescence and it can negatively affect testicular growth, histology and function. The use of early varicocelectomy to prevent severe testicular damage and sub-infertility in adulthood seems to be incontrovertible. However there is a difference of opinion as to the proper surgical procedure of varicocele ablation. To date, the inguinal and high retroperitoneal approaches are the most commonly accepted methods. However significant postoperative morbidity is common, with a recurrence rate ranging from 1 to 25% and return to normal activity often is prolonged. This considerations have prompted many to search for alternative techniques. The Authors performed laparoscopic clipping and division of the internal spermatic vein or the internal spermatic vessels in 55 adolescents to treat varicocele. Indications for the operation were third degree varicocele and second degree with testicular hypotrophy. At a mean 6 months follow-up, they did not observe either relapses or complications; no hydrocele was noted and testicular size did not decrease in any patient. In the Authors' experience and opinion, laparoscopic varicocelectomy is a simple, safe, effective and minimally invasive surgical procedure and it can be proposed as a viable alternative to open traditional surgical methods.
精索静脉曲张最早在青春期早期出现，会对睾丸的生长、组织学和功能产生负面影响。采用早期精索静脉高位结扎术预防成年期严重的睾丸损害和亚不育症，这一点似乎无可争议。然而，对于精索静脉曲张消融的恰当手术方法存在不同意见。迄今为止，腹股沟和高位腹膜后途径是最常用的方法。然而，术后明显的发病率很常见，复发率在1%至25%之间，恢复正常活动通常也会延长。这些考虑促使许多人寻找替代技术。作者对55名青少年进行了腹腔镜下精索内静脉或精索内血管的夹闭和切断以治疗精索静脉曲张。手术指征为三度精索静脉曲张和伴有睾丸萎缩的二度精索静脉曲张。平均随访6个月时，他们未观察到复发或并发症；未发现鞘膜积液，且所有患者的睾丸大小均未减小。根据作者的经验和观点，腹腔镜精索静脉高位结扎术是一种简单、安全、有效且微创的手术方法，可作为传统开放手术方法的可行替代方案。
