Lopez C, Serres-Cousine O, Averous M
Service d'Urologie II, CHU Lapeyronie, Montpellier, France.
Prog Urol. 1998 Jun;8(3):382-7.
The authors report their experience of the treatment of varicocele in adolescents. As a result of progress in interventional radiology and embolization techniques, they have used a technique combining sclerotherapy and percutaneous embolization since 1993.
Since 1993, twenty three adolescents between the ages of 11 and and 17 years (mean = 14.5 years) were treated percutaneously for grade II and II left varicocele. The operation was performed under local anaesthesia and/or neuroleptanalgesia. Phlebography by selective catheterization of the left spermatic vein was performed for anatomical assessment (ostial incontinence, collateral vessels). Embolization was then performed under fluoroscopic control by injection of a sclerosing liquid, sodium tetradecyl sulphate (Trombovar), and systematically completed by insertion of endovascular occlusive metal coils.
The follow-up ranged from 6 to 48 months (mean = 30 months). The follow-up clinical and ultrasound examination showed complete disappearance of the varicocele in 22 cases (95% of cases), with a persistent grade I asymptomatic left varicocele in 1 case. No complications were observed. The mean hospital stay was 48 hours.
This constitutes a rapid method, which is minimally traumatic for the adolescent. Its efficacy is comparable to that of classical surgical techniques with lasting results. Insertion of coils is the endovascular equivalent of surgical ligation of the pathological vein. The liquid embolus is particularly useful as it diffuses and scleroses collateral veins, responsible for recurrence. The advantage of this method resides in a better understanding of the reflux mechanisms, allowing the procedure to be adapted to the venous anatomy. This technique ensures treatment of complex varicoceles, such as postsurgical recurrences.
作者报告他们治疗青少年精索静脉曲张的经验。由于介入放射学和栓塞技术的进步，自1993年以来他们采用了一种硬化疗法与经皮栓塞相结合的技术。
自1993年起，对23名年龄在11至17岁（平均14.5岁）的青少年经皮治疗II级和III级左侧精索静脉曲张。手术在局部麻醉和/或神经安定镇痛下进行。通过选择性导管插入左侧精索静脉进行静脉造影以进行解剖学评估（开口失禁、侧支血管）。然后在荧光透视控制下通过注射硬化液十四烷基硫酸钠（Trombovar）进行栓塞，并通过插入血管内闭塞金属线圈系统地完成栓塞。
随访时间为6至48个月（平均30个月）。随访的临床和超声检查显示22例（95%的病例）精索静脉曲张完全消失，1例左侧I级无症状精索静脉曲张持续存在。未观察到并发症。平均住院时间为48小时。
这是一种快速的方法，对青少年创伤极小。其疗效与传统手术技术相当，效果持久。插入线圈相当于对病变静脉进行手术结扎的血管内操作。液体栓塞剂特别有用，因为它能扩散并硬化导致复发的侧支静脉。这种方法的优点在于能更好地理解反流机制，使操作能适应静脉解剖结构。该技术可确保治疗复杂的精索静脉曲张，如术后复发。
