Kattan S
Department of Surgery, College of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Scand J Urol Nephrol. 1998 Sep;32(5):335-40. doi: 10.1080/003655998750015296.
To determine the incidence and pattern of recurrence of varicocele after laparoscopic internal spermatic vein ligation with testicular artery preservation.
In a prospective study, 16 patients who underwent 20 laparoscopic varix ligation were evaluated postoperatively for recurrence by clinical physical examination and percutaneous spermatic venography.
No significant complications were encountered with the surgical or radiological procedure. Clinical recurrence was detected by physical examination in 20% of cases, while percutaneous spermatic venography detected recurrence in 45% of cases. The sensitivity and specificity of clinical physical examination for detecting varicocele recurrence was 33% and 90.9%, respectively with an accuracy rate of 65%. Recurrences were through parallel collaterals or medial transverse collaterals in 88.8% and 11.2%, respectively. Parallel collaterals joined the spermatic vein in mid or high retroperitoneum in seven patients while it joined the renal vein in one patient. There were no low retroperitoneal parallel collaterals.
Laparoscopic ligation of internal spermatic vein with preservation of testicular artery is a procedure that is associated with low morbidity and quick recovery. It is able to achieve its surgical objective in only 55% of cases, however. Such information should be taken into consideration during patient counselling when selecting the operative technique of choice for varicocele ligation.
确定保留睾丸动脉的腹腔镜下精索内静脉结扎术后精索静脉曲张的复发率及复发模式。
在一项前瞻性研究中，对16例行20次腹腔镜下精索静脉曲张结扎术的患者术后通过临床体格检查和经皮精索静脉造影评估复发情况。
手术或放射学操作均未出现明显并发症。临床体格检查发现20%的病例复发，而经皮精索静脉造影发现45%的病例复发。临床体格检查检测精索静脉曲张复发的敏感度和特异度分别为33%和90.9%，准确率为65%。复发分别通过平行侧支或内侧横向侧支，比例分别为88.8%和11.2%。7例患者的平行侧支在腹膜后中高位汇入精索静脉，1例患者的平行侧支汇入肾静脉。无腹膜后低位平行侧支。
保留睾丸动脉的腹腔镜下精索内静脉结扎术是一种发病率低、恢复快的手术。然而，该手术仅在55%的病例中能达到手术目的。在为精索静脉曲张结扎术选择首选手术技术时，向患者咨询时应考虑到这些信息。
