Peterson A C, Lance R S, Ruiz H E
Urology Service, Madigan Army Medical Center, Tacoma, Washington, USA.
J Urol. 1998 May;159(5):1565-7. doi: 10.1097/00005392-199805000-00043.
Surgical ligation is an option in the management of patients with painful varicocele. Little objective data exist addressing the effectiveness of this treatment. We reviewed records from 58 patients who underwent varicocele ligation at our institution from January 1985 to May 1996 to establish success of surgical ligation of the painful varicocele.
ICD-9 billing codes were used to identify all patients who had undergone varicocele ligation for pain since 1985. We documented patient age, grade and location of varicocele, duration and quality of pain, response to conservative therapy and surgical approach to ligation. Telephone interviews and chart reviews were conducted to determine resolution of pain, complications of the procedure and if the patient would choose surgery again.
We obtained followup on 35 of the 58 painful varicocele patients (60%). Average patient age was 25.7 years (range 15 to 65). The varicocele was on the left side in 30 men and bilateral in 5. Of the patients 31 described the pain as a dull throbbing ache, 2 as sharp and 2 as a pulling sensation. Initial conservative therapy failed in all 35 men. Varicocele was grade III in 18 cases, grade II in 16 and grade I in 1. The inguinal or subinguinal approach was used in 24 patients, high ligation in 10 and laparoscopic repair in 1. In 30 patients there was (86%) complete resolution of pain postoperatively and 1 had partial resolution. Only 4 patients (11%) had persistent or worse symptoms.
This retrospective review supports the conclusion that varicocele ligation is an effective treatment for painful varicocele in properly selected patients.
手术结扎是治疗疼痛性精索静脉曲张患者的一种选择。关于这种治疗方法的有效性，客观数据较少。我们回顾了1985年1月至1996年5月在本机构接受精索静脉曲张结扎术的58例患者的记录，以确定疼痛性精索静脉曲张手术结扎的成功率。
使用国际疾病分类第九版（ICD - 9）计费代码识别自1985年以来因疼痛接受精索静脉曲张结扎术的所有患者。我们记录了患者的年龄、精索静脉曲张的分级和位置、疼痛的持续时间和性质、对保守治疗的反应以及结扎的手术方式。通过电话访谈和病历审查来确定疼痛是否缓解、手术并发症以及患者是否会再次选择手术。
我们对58例疼痛性精索静脉曲张患者中的35例（60%）进行了随访。患者平均年龄为25.7岁（范围15至65岁）。30例患者的精索静脉曲张位于左侧，5例为双侧。31例患者将疼痛描述为钝痛，2例为锐痛，2例为牵拉感。所有35例患者的初始保守治疗均失败。精索静脉曲张分级为III级的有18例，II级的有16例，I级的有1例。24例患者采用腹股沟或腹股沟下途径，10例采用高位结扎，1例采用腹腔镜修复。30例患者（86%）术后疼痛完全缓解，1例部分缓解。只有4例患者（11%）症状持续或加重。
这项回顾性研究支持以下结论，即对于经过适当选择的患者，精索静脉曲张结扎术是治疗疼痛性精索静脉曲张的有效方法。
