青少年精索静脉曲张诊断评估与治疗干预新进展

Recent advances in the evaluations and managements of adolescent varicocele

青少年精索静脉曲张(varicocele,VC)发病率不断增高,对患儿身体发育和生殖健康带来显著影响,已引起医学界广泛关注。VC的发病原因除了已知的解剖因素外,还包括胡桃夹现象(nutcracker phenomenon,NCP)、遗传因素等,对青少年VC的临床诊断和评估至关重要。精液检查虽然是对VC疾病最准确的评估措施,但在青少年患儿中往往无法获取精液样本,除此之外,监测双侧睾丸体积发育差异、彩色多普勒血流成像、内分泌检查等方法也是很有意义的评估依据和随访措施。青少年VC的治疗方案主要包括观察随访和外科干预,争论的焦点集中在手术指征及对手术方案的选择上。虽然目前仍无充足证据证明在传统开放手术、腹腔镜手术和显微镜精索静脉结扎术中哪种是最佳的手术方式,但是术中保留淋巴管可以显著减少手术并发症,特别是显微外科技术可以清晰显示精索内动脉、静脉及淋巴管等结构,在青少年VC手术治疗方面有良好的应用前景,但其技术优势仍需更多的循证医学证据。

A rising incidence of varicocele(VC)has exerted a significant impact on physical development and reproductive health of adolescents.It has attracted a lot of attention in medical community.In addition to known anatomical factors,the causes of VC also include nutcracker phenomenon(NCP),genetic factors and so on.Although semen examination is the most accurate assessment measure for VC,collecting samples is virtually impossible in adolescents.Also monitoring testicular volume development variations,color Doppler flow imaging and endocrine examinations are essential for assessments and follow-ups.The major treatments include observations,follow-ups and surgical interventions.Currently the focus of debate is on surgical indications and options.Although there is still no sufficient evidence to prove whether traditional open surgery,laparoscopy microscopic spermatic vein ligation is the optimal approach,intraoperative preservation of lymphatic vessels can significantly reduce surgical complications.And microsurgical techniques can distinctly visualize internal spermatic artery,vein and lymphatic vessels and other structures.Thus it offers an excellent application prospect for adolescent VC.However,its technical advantages should be confirmed by more evidence-based clinical trials.