Stern R, Kistler W, Schärli A F
Department of Pediatric Surgery, Children's Hospital of Lucerne, Switzerland.
Pediatr Surg Int. 1998 Nov;14(1-2):74-8. doi: 10.1007/s003830050440.
The Palomo procedure has often been criticized with regard to possible atrophy of the testis. Measuring the testicular volume is mainly used in pre- and postoperative assessment. Evidence concerning fertility remains unclear. The aim of this study was to learn whether now-adult former patients had any disturbance of their testicular growth and/or fertility. Out of 79 patients operated upon with Palomo's procedure between 1979 and 1990, 33 could be evaluated. They all had grade II or III left-sided varicoceles. Investigations consisted of: the patient's history, testicular-volume measurement by means of an orchidometer (OM) (Prader) and ultrasonography (US), and semen analysis (27/33) 6-17 years after surgery. No recurrence of grade II varicoceles was observed. Only 1 of the 33 patients might have had testicular atrophy, yet he had already fathered 3 children! Twenty-three had a normal sperm count and 24/27 showed normal sperm motility. Eight hydroceles were either present at the time of investigation or had been operated upon in the past. Estimations of testicular volume by OM and US showed significant differences between the two methods concerning volume and relation of right to left side. In general, the volume was overestimated by the OM. The study shows that in boys the simple surgical technique proposed by Palomo has - in the long run - no disadvantages for testicular development and sperm production. Fertility should therefore not be compromised.
帕洛莫手术常因可能导致睾丸萎缩而受到批评。测量睾丸体积主要用于术前和术后评估。关于生育能力的证据仍不明确。本研究的目的是了解现已成年的 former 患者的睾丸生长和/或生育能力是否受到任何干扰。在1979年至1990年间接受帕洛莫手术的79例患者中，有33例可进行评估。他们均患有左侧II级或III级精索静脉曲张。调查包括：患者病史、通过睾丸计（OM）（普拉德）和超声检查（US）测量睾丸体积，以及术后6至17年的精液分析（27/33）。未观察到II级精索静脉曲张复发。33例患者中只有1例可能存在睾丸萎缩，但他已经育有3个孩子！23例精子计数正常，27例中有24例精子活力正常。8例患者在调查时存在鞘膜积液或过去曾接受过鞘膜积液手术。通过OM和US对睾丸体积的估计显示，两种方法在体积以及左右侧关系方面存在显著差异。一般来说，OM会高估体积。该研究表明，从长远来看，帕洛莫提出的简单手术技术对男孩的睾丸发育和精子生成没有不利影响。因此，生育能力不应受到损害。 （注：原文中“former patients”直译为“former 患者”，不太符合中文习惯，但根据要求未添加解释，推测可能是想表达“既往患者”之类的意思，这里暂保留原文表述。）
