Casciola L, Ceccarelli G, Mazzoli W, Di Zitti L, Giulianelli F, Fedeli C, Flamini F O
Unità Operativa, Azienda USL n. 3, Regione Umbria, Ospedale di Spoleto, Perugia.
Minerva Chir. 1998 Mar;53(3):153-61.
It is now unquestionable that varicocele represents one of the main causes of male infertility, and thus requires appropriate surgical treatment. Inguinal and retroperitoneal methods have for some time been the most widely used. However, a significant postoperative morbidity and relatively long convalescence have prompted the search for alternative surgical techniques, such as percutaneous sclero-embolisation and microsurgery. Laparoscopic treatment of varicocele is a relatively recent surgical technique. The first studies by Sanchez de Badajoz date back to 1988 and to date a relatively small number of cases have been reported. The authors analyse the results in 54 patients treated over a period of two and a half years; 13 cases also presented inguinal hernia pathology which was treated during the same operation by applying a polypropylene graft again using a laparoscopic approach; the latter method has been routinely applied since 1992 in over 1000 cases with excellent results. The internal spermatic artery was always identified and preserved. No peri- or postoperative complications were observed. A follow-up was performed at 10 months after surgery and showed results which although referred to a relatively small series, were certainly better than those reported in the literature using traditional surgical techniques; in addition, this method also reveals interesting possibilities for the treatment of associated pathologies during the same operation, with obvious advantages in terms of costs and patient compliance.
现在毫无疑问，精索静脉曲张是男性不育的主要原因之一，因此需要适当的手术治疗。腹股沟和腹膜后手术方法曾一度是使用最广泛的。然而，较高的术后发病率和相对较长的恢复期促使人们寻找替代手术技术，如经皮硬化栓塞术和显微手术。腹腔镜治疗精索静脉曲张是一种相对较新的手术技术。桑切斯·德·巴达霍斯的首批研究可追溯到1988年，迄今为止报道的病例数量相对较少。作者分析了在两年半时间里治疗的54例患者的结果；其中13例还伴有腹股沟疝病变，在同一手术中通过再次使用腹腔镜方法应用聚丙烯移植物进行治疗；自1992年以来，后一种方法已在1000多例病例中常规应用，效果良好。始终识别并保留精索内动脉。未观察到围手术期或术后并发症。术后10个月进行了随访，结果显示，尽管该系列病例相对较少，但肯定优于使用传统手术技术的文献报道；此外，这种方法还显示出在同一手术中治疗相关病变的有趣可能性，在成本和患者依从性方面具有明显优势。
