精索曲张静脉切除术后持续性静脉逆流
作者：Jason P. Van Batavia, Angela M. Fast, Shannon N. Nees, Miguel A. Mercado, et al. 来源：Journal of Urology 日期：2013-03-12
导读
Incidence, Significance, and Natural History of Persistent Retrograde Venous Flow Post-Varicocelectomy in Children and Adolescents: Correlation with Catch-up Growth
Abstract
Purpose
Varying incidences and levels of persistent RVF have been reported following adult and adolescent varicocelectomy but its significance remains unclear. We sought to determine the incidence and natural history of persistent flow and whether it had any affect on post-operative CUG.
Methods
We retrospectively analyzed pre- and post-varicocelectomy DDUS findings. PRF, MVD, flow quality, and varicocele grade were recorded at each visit. CUG was defined as <15% asymmetry at final visit.
Results
Of total 330 varicocelectomy patients (247 laparoscopic, 83 open; median age 15.4yr), 145 (44%) had residual RVF with a mean PRF of 13.3cm/sec. Of 290 with repeat DDUS (median follow-up time 2.6 yr), 124 had initial PRF <20cm/sec (43%) and only 17 had PRF ≥20cm/sec (6%). Incidence of post-varicocelectomy RVF at last visit was similar to that at initial post-op visit (49% initial vs. 48% final). Twenty of 330 boys had recurrence of palpable varicocele (grade 2 or 3); 18 boys (90%) had initial RVF. CUG was more likely in patients with no RVF and rates of CUG decreased as PRF increased. All 5 patients with initial testicular asymmetry and persistent RVF at levels >30cm/sec had continued testicular asymmetry (ie, none had CUG).
Conclusion
RVF is frequently present post-varicocelectomy and when it does occur it almost always is associated with PRFs significantly lower than those seen in patients who are recommended for initial varicocelectomy. RVF tends to persist during follow-up at stable PRFs. Palpable recurrence and persistent asymmetry is most often associated with post-operative PRFs ≥20cm/sec.
http://www.jurology.com/article/S0022-5347(13)03524-6/abstract
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