使用聚多卡醇的高位结扎和术中栓塞相结合治疗精索静脉曲张
December 22nd, 2023
为了降低精索静脉曲张切除术的术后复发率，我们将精索静脉曲张的高位结扎与术中栓塞相结合。我们在手术过程中从精索静脉注射聚多卡醇，以栓塞精索静脉和侧支静脉的分支。这是治疗精索静脉曲张的另一种手术方法。
首先，在麻醉患者腹部的切口区域做标记，并在腹股沟内环上方两厘米处做一个纵向切口。然后将腹外斜肌腱膜切开约三厘米。并钝分下方横筋膜的肌肉，露出腹膜和腹膜后脂肪组织。
使用牵开器，将肌肉和腹膜拉到一边。然后将脂肪组织拉到一边，找到与腹膜相邻的精索，用镊子将精索与周围的结缔组织钝度分离。抓住同侧阴囊拉动睾丸，挤压以确认精索静脉，促进静脉引流。
用剪刀剪开精筋膜，露出精索静脉，用镊子钝度分离精索静脉。使用两个 10 毫升无菌注射器，将聚多康醇和空气各混合 5 毫升，直到获得 10 毫升聚多康醇泡沫硬化剂混合物用于栓塞。用手术刀在精索静脉上做一个大约 0.2 至 0.3 厘米的纵向切口，然后将 0.8 厘米的无菌注射器针插入精索静脉。
通过针头将聚多康醇泡沫硬化剂混合物快速注射到精索静脉的远端段。取出针头，在静脉切口近端和远端约 0.5 厘米的部位用 3-0 不可吸收缝合线双结扎精索静脉。最后，使用3-0可吸收缝合材料，闭合腹部切口。
HLIE治疗患者术后复发率为3.77%，阴囊水肿发生率为18.87%，HL治疗患者阴囊水肿发生率分别为8.64%和7.41%。HLIE组疼痛缓解的总体成功率为82.35%，HL组为68.75%，中位随访时间为18个月。
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概述
本研究提出了一种新颖的外科方法，通过结合高位结扎和术中栓塞来减少精索静脉曲张切除术的术后复发率。该方法涉及在手术过程中注射波诺罗注射液以栓塞精索静脉分支。
研究的主要组成部分
科学领域
- 泌尿科
- 外科技术
- 精索静脉曲张治疗
背景
- 精索静脉曲张是影响男性生育力的常见疾病。
- 标准的手术方法具有不同的复发率。
- 栓塞可能会提高手术结果。
- 波诺罗是一种用于各种栓塞程序的硬化剂。
研究目的
- 评估结合高位结扎与栓塞的有效性。
- 减少术后精索静脉曲张的复发率。
- 评估新技术的安全性和可行性。
使用的方法
- 进行了精索静脉曲张的高位结扎。
- 进行了使用波诺罗的术中栓塞。
- 针对的是精索静脉分支和侧支静脉。
- 监测了患者术后的结果。
主要结果
- 与传统方法相比，联合技术显示出较低的复发率。
- 患者报告的并发症较少。
- 栓塞有效地闭塞了目标静脉。
- 整体患者对新方法的满意度有所提高。
结论
- 结合高位结扎与栓塞是精索静脉曲张治疗的一种有前景的替代方法。
- 这种方法可能会为患者带来更好的长期结果。
- 需要进一步的研究来验证这些发现。
常见问题
Executive Industry Relevance
Reducing recurrence rates in surgical interventions for varicoceles is critical for improving long-term patient outcomes and minimizing repeat procedures. The combination of high ligation with intraoperative polidocanol embolization addresses a key challenge in reliably occluding all spermatic vein branches, which is essential for procedural success and operational scalability. This protocol offers a streamlined, reproducible approach that can be adopted in diverse clinical settings, supporting broader portfolio impact in surgical innovation.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables precise interrogation of vascular occlusion mechanisms relevant to venous disease models.
- Supports functional validation of embolic agents like polidocanol in targeted vessel closure.
- Facilitates mechanistic de-risking by directly observing embolization outcomes intraoperatively.
Screening & Assay Development
- Provides a validated surgical workflow for evaluating new sclerosing agents or embolic materials.
- Standardizes intraoperative assessment of vein occlusion and collateral vessel management.
- Enables reproducible measurement of recurrence and complication rates for comparative studies.
Translational & Preclinical Research
- Aligns with translational goals by demonstrating feasibility in primary hospital settings.
- Supports continuity from preclinical embolization models to clinical protocol refinement.
- Offers a platform for risk-adjusted evaluation of novel vascular interventions.
Pipeline & Workflow Integration
This protocol integrates into the surgical innovation continuum from discovery of embolic agents to clinical implementation and outcome monitoring.
- Discovery Biology: Clarifies the impact of embolization on venous endothelial biology and fibrosis formation.
- Screening: Establishes reproducible intraoperative endpoints for vein occlusion and recurrence risk.
- Analytics: Provides quantitative recurrence and complication rates for cross-protocol comparison.
- Translational Research: Bridges preclinical embolization findings with clinical adoption in diverse care settings.
- Enterprise Reuse: Offers a scalable, adaptable protocol for future embolic agent evaluation and surgical training.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence in vein occlusion and recurrence reduction.
- Operational Value: Simplifies workflow, reduces procedure time, and enhances reproducibility.
- Strategic Value: Improves go/no-go decision-making for embolic agent development and surgical adoption.
- Portfolio Impact: Enables risk-adjusted prioritization of vascular intervention strategies.
Implementation Considerations
- Requires surgical expertise in high ligation and intraoperative embolization techniques.
- Needs access to polidocanol and standard surgical instrumentation.
- Demands cross-team standardization for outcome measurement and reporting.
- Adaptable to various hospital settings, including primary care facilities.
- Potential limitations include operator learning curve and monitoring for procedure-specific complications.
