精索静脈瘤に対する高位結紮術の治療成績

Treatment results of high-ligation surgery for varicoceles

　2006年1月〜2013年12月にかけて，精索静脈瘤に対し高位結紮術を施行した18例を対象とし，治療効果を検討した．初診時年齢中央値は33±7.4歳，静脈瘤は全例左側に認め（両側3例），静脈瘤のグレードはⅠ5例，Ⅱ12例，Ⅲ4例であった．左側16例，両側2例に手術施行，手術時間中央値は53±8.8分（左側のみ施行n＝16）であった．17/18例（94％）で静脈瘤は消失，1例で術後陰囊水腫を認めた．

　男性不妊14例の精液検査で精子濃度10例（71％），運動率7例（50％）において改善を認めた．妊娠は7例（50％），挙児は4例（29％）に得られた．精索静脈瘤に対する高位結紮術は安全に施行でき，男性不妊症に対しても精液所見の改善効果が期待できる有用な治療法であると考えられた．

Abstract

In the period of January 2006 to December 2013, 18 patients who underwent high-ligation surgery for varicoceles were retrospectively evaluated for assessing therapeutic efficacy. At the first visit, the median age was 33 ± 7.4 years. In all cases, varicoceles were observed on the left side (both sides in 3 patients) with a varicocele grade I in 5 cases, grade II in 12 cases, and grade III in 4 cases.

Surgery was performed on the left-side in 16 and both-side in 2 cases. Median operation time was 53 ± 8.8 minutes (left enforcement n = 16). Therapeutic efficacy was observed in 17 patients (98%), and the postoperative complication of hydrocele of the testis occurred in only one case.

Semen examination of 14 male-infertility patients revealed improvement of the sperm concentration in 10 patients (71%), the exercise rate in 7 patients (50%). Pregnancy occurred in 7 patients (50%), and the birth of the child was achieved in 4 patients (29%) with the combination of assisted reproductive technology.

High ligation surgery for varicocele is demonstrated to be safe and effective. With respect to infertility treatment, a synergistic effect may occur by combining assisted reproductive technology with this operative procedure (Rinsho Hinyokika 72 : 81-85, 2018).