72例精索静脉曲张硬化治疗的回顾性分析

Sclerotherapy of Varicocele: A Retrospective Analysis of 72 Cases

目的 探讨精索静脉的形态分型及其对硬化治疗的影响。资料与方法 回顾性分析 72例左侧精索静脉造影的表现和硬化治疗情况 ,将精索静脉分为单开口型、多开口型及复杂交通型 ,前二者又进一步分为单支型和多支型 ,并统计各型的硬化治疗率。结果 造影成功率 83.3% (6 0 / 72 ) ,曲张硬化治疗率 73.2 % (41/ 5 6 ) ,单支单开口型、单支多开口型、多支单开口型静脉曲张硬化率均为 10 0 % ;多支多开口型和复杂交通型静脉曲张硬化率分别为 14 .3%和 0。结论 (1)精索静脉的形态分型方法简单、直观 ,有助于硬化治疗方案的确定。 (2 )先作非选择性造影 ,再作选择性血管造影有助于提高阳性率。 (3)精索静脉曲张的硬化治疗没有绝对禁忌症 ,不论何种形态、有无侧支 ,只要没有不可控制的返流 ,精索静脉包括侧支在内都可以栓塞。

Objective To discuss the morphologic classification of the spermatic veins, and its significance in the sclerotic treatment of varicocele.Materials and Methods The left internal spermatic venographic findings and the sclerotherapeutic results in 72 patients with left varicocele were retrospectively analyzed. The spermatic veins were classified into three types: (1) single orifice type, (2) multi orifice type, and (3) complicated communication type. The single and multi orifice types were further divided into subtypes of single branch or multi branch. The sclerotherapeutic results of each type were separately calculated. Results The successful rate of venography was 83.3% (60/72), and the cure rate of varicocele was 73.2% (41/56). The sclerotic rate of varicocele in cases of single branch with single orifice type, single branch with multi orifice type, and multi branch with single orifice type was 100%, while in multi branch with multi orifice type and complicated communication type it was 14.3% and 0%, respectively.Conclusion (1) This anatomical classification of the spermatic veins is simple and practical. (2) Non selective angiography should be performed before selective angiography, which is helpful in detecting varicocele. (3) As long as no uncontrolled spermatic venous reflux exists, there is no absolute contraindication in the treatment of varicocele with percutaneous sclerotherapy.