Lemack G E, Uzzo R G, Schlegel P N, Goldstein M
James Buchanan Brady Foundation, Department of Urology, New York Hospital-Cornell Medical Center, New York 10021, USA.
J Urol. 1998 Jul;160(1):179-81.
Since clinically apparent varicoceles may affect testicular volume and sperm production, early repair has been advocated. However, repair of the pediatric varicocele with conventional nonmagnified techniques may result in persistence of the varicocele after up to 16% of these procedures. Also testicular artery injury and postoperative hydrocele formation can occur after nonmagnified repair. The microsurgical technique has been successfully completed in a large series of adults with a dramatic reduction in complication and recurrence rates. We report our experience with the microsurgical technique in boys.
A total of 30 boys (average age 15.9 years) underwent 42 microsurgical varicocelectomies (12 bilateral). All patients had a large left varicocele. Indications for repair included testicular atrophy (size difference between testicles of greater than 2 ml.) in 20 boys, pain in 5 and a large varicocele without pain or testicular atrophy in 5. Six boys were referred following failure of conventional nonmicrosurgical techniques. All boys were examined no sooner than 1 month postoperatively (mean followup 12).
Preoperative volume of the affected testis averaged 13.0 ml., and an average size discrepancy between testicles of 2.8 ml. was noted before unilateral varicocelectomy. No cases of persistent or recurrent varicoceles were detected, and 1 postoperative hydrocele resolved spontaneously. After unilateral varicocelectomy the treated testes grew an average of 50.1%, while the contralateral testes grew only 23%. Overall, 89% of patients with testicular atrophy demonstrated reversal of testicular growth retardation after unilateral varicocelectomy. In contrast, both testes showed similar growth rates after bilateral varicocelectomy (45% left testis, 39% right testis).
The meticulous dissection necessary to preserve arterial and lymphatic supply, and to ligate all spermatic veins in the pediatric patient is readily accomplished using a microsurgical approach, and results in low recurrence and complication rates. Rapid catch-up growth of the affected testis after microsurgical varicocelectomy suggests that intervention during adolescence is effective and warranted.
由于临床上明显的精索静脉曲张可能影响睾丸体积和精子生成，因此主张早期修复。然而，采用传统非放大技术修复小儿精索静脉曲张，在高达16%的此类手术中可能导致精索静脉曲张持续存在。而且非放大修复后可能发生睾丸动脉损伤和术后鞘膜积液形成。显微外科技术已在大量成年患者中成功完成，并发症和复发率显著降低。我们报告我们在男孩中应用显微外科技术的经验。
共有30名男孩（平均年龄15.9岁）接受了42例显微外科精索静脉结扎术（12例双侧）。所有患者均有巨大的左侧精索静脉曲张。修复指征包括20名男孩的睾丸萎缩（两侧睾丸大小差异大于2毫升）、5名男孩的疼痛以及5名男孩无疼痛或睾丸萎缩的巨大精索静脉曲张。6名男孩在传统非显微外科技术失败后前来就诊。所有男孩术后至少1个月接受检查（平均随访12个月）。
患侧睾丸术前平均体积为13.0毫升，单侧精索静脉结扎术前两侧睾丸平均大小差异为2.8毫升。未发现精索静脉曲张持续或复发的病例，1例术后鞘膜积液自行消退。单侧精索静脉结扎术后，治疗侧睾丸平均增长50.1%，而对侧睾丸仅增长23%。总体而言，89%的睾丸萎缩患者在单侧精索静脉结扎术后睾丸生长迟缓得到逆转。相比之下，双侧精索静脉结扎术后两侧睾丸显示出相似的生长速率（左侧睾丸45%，右侧睾丸39%）。
使用显微外科方法很容易完成小儿患者中保留动脉和淋巴供应以及结扎所有精索静脉所需的精细解剖，并且复发率和并发症率较低。显微外科精索静脉结扎术后患侧睾丸的快速追赶生长表明青春期进行干预是有效且必要的。
