显微镜下精索静脉结扎术治疗青春期精索静脉曲张

Microsurgical varicocelectomy for varicocele in adolescence

目的 青春期精索静脉曲张的转归和治疗日益被重视，本文就显微镜下精索静脉结扎术治疗精索静脉曲张的疗效进行分析。方法 回顾性分析自2006年3月至2010年8月我们收治的26例青春期精索静脉曲张患儿临床资料，年龄10—18岁，平均年龄14．4岁。就诊原因包括睾丸或阴囊涨痛10例，阴囊外观异常4例，体检发现12例。术前均行彩色多普勒超声检查测定睾丸体积、曲张精索内静脉最大内径及反流时间。患儿均接受显微镜下精索静脉结扎术。手术取腹股沟外环口下方切口，提出精索，在放大8～15倍手术显微镜下逐一结扎离断精索静脉，术中淋巴管和动脉予以完整保留。结果 术后随访3～12个月，所有患儿未见睾丸萎缩，阴囊鞘膜积液，精索静脉曲张复发。2例术后1个月内出现阴囊水肿，3个月内自然缓解。21例术前患侧睾丸发育迟缓患儿16例出现恢复性生长。结论 青春期精索静脉曲张采取腹股沟外环口下方的显微镜下精索静脉结扎术可以在彻底结扎曲张静脉的同时，保护睾丸的动脉及淋巴管系统，是一种安全、有效的手术方法。

Objective There are many reports on adolescents with varicocele about the prognosis and treatments nowadays. We examined the efficacy of microsurgical varicocelectomy, and aimed to find a good method of varicocele repair to adolescents. Methods We carried out varicocelectomy on 26 boys with a median age of 14.4 （ range, 10 to 18 ） from March 2006 to August 2010 in our hospital. Ten of them came to hospital for the pain of testicle and scrotum, four for the abnormal scrotum appearances, and twelve patients were found by physical examination. We had the color doppler ultrasound test on testicular volume, the maximum venous inner diameter and the backstreaming time. All patients accepted the microsurgieal varicocelectomy which had the incision under the outside inguinal ring and uses the microscope by 8 times to 15 times. During the surgery, lymphatic vessels and testicular arteries are reserved completed. Results There was no case of testicle atrophy, hydroceie or recurrence with the follow-up of 3 to 12 months. Two patients had scrotum edema after operation and recovered in one month. Of the 21 boys with testicular growth arrest 16 had catch - up growth in testicle. Conclusion Microsurgical varicocelectomy is a safe and effective treatment for the varicoeeles in adolescents.