Madjar S, Moskovitz B, Issaq E, Weinberger M, Nativ O
Department of Urology, Bnai Zion Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa.
Int Urol Nephrol. 1998;30(1):69-73. doi: 10.1007/BF02550281.
The purpose of this study was to evaluate the efficacy of low inguinal (or subinguinal) approach in the treatment of recurrent or persistent varicocele after surgical treatment. Recurrent varicocele was diagnosed in 23 patients who previously underwent surgical treatment. The technique used consisted of low inguinal incision at the level of the external inguinal ring without opening the external oblique aponeurosis. External spermatic veins (cremasteric veins) were dissected and selectively ligated. Then the spermatic fascia was incised and the internal spermatic veins were identified and ligated individually. Postoperative radioisotope scan, scrotal examination and sperm analysis were used for treatment evaluation. Twenty-one (91.3%) had negative postoperative scan and no signs of varicocele on physical examination. A marked improvement of sperm analysis was noted in 19 patients (p<0.05), while two had only minor improvement. Two patients had positive postoperative scans without improvement of semen analysis. Neither atrophy nor azoospermia were detected on follow-up examination in any of these men, however, one patient developed hydrocele. This study indicates a good surgical outcome and improvement of semen quality without significant complications.
本研究的目的是评估低位腹股沟（或腹股沟下）入路在治疗手术治疗后复发或持续性精索静脉曲张中的疗效。23例曾接受过手术治疗的患者被诊断为复发性精索静脉曲张。所采用的技术包括在腹股沟外环水平做低位腹股沟切口，不打开腹外斜肌腱膜。解剖并选择性结扎精索外静脉（提睾肌静脉）。然后切开精索筋膜，识别并分别结扎精索内静脉。术后使用放射性同位素扫描、阴囊检查和精液分析进行治疗评估。21例（91.3%）术后扫描结果为阴性，体格检查无精索静脉曲张迹象。19例患者精液分析有显著改善（p<0.05），而2例仅有轻微改善。2例患者术后扫描结果为阳性，精液分析无改善。在这些男性的随访检查中均未发现萎缩或无精子症，然而，1例患者出现了鞘膜积液。本研究表明手术效果良好，精液质量得到改善，且无明显并发症。
