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 Varicocelul dr Ioan COMAN

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Page 1: 4. Varicocelul

5/13/2018 4. Varicocelul - slidepdf.com

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Varicoceluldr Ioan COMAN

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Varicocelul Def. Dilataia varicoas a venelor 

spermatice localizat la nivelulcordonului

(E. Proca)

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Etiopatogenie VARICOCELUL PRIMITIV ± dilatarea se

 produce dup vârsta pubertii (15-35 ani)

 predomin partea stâng

vena spermatic stâng

avalvulat

se vars în VRS în unghi drept

VARICOCELUL SIMPTOMATIC nu are o parte favorit

obstacol extrinsec : adenopatii, tu renale, etc.

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Anatomie patologic varicozitile: grupul venos spermatic

anterior 

asociat apare subierea prin atrofie a

muchilor cremaster i dartos

staza sangvin cu timpul duce la tulburri

ale spermatogenezei

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Tablou clinic varicocelul de volum moderat nu produce

nici o simptomatologie

 jen scrotal

greutate la nivelul scrotului

EX OB:

scrot alungit asimetric

 partea bolnav atârn flasc

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Palpare

³rsucirea între degete a unor intestine de

 pasre´

ectazii venoase

manifestri de boli de colagen

hernii de slbiciune

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Diagnostic

Clinic pe baza caracteristicilor descrise

Dg diferenial dintre originea primitiv sau

secundar a suferinei

Refluxul venos:

eco Doppler spermatic (Valsalva)

flebografie

 

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Evoluia extrem de lent

senzaii locale penibile

tulburri trofice ale testicolului i teg.

scrotal

lipsa de igien flebit spermatic,

tromboze definitive

 

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Tratament

Indicaii pentru cura chirurgical:

volum important

senzaii subiective insuportabile

cuplu steril / oligoastenospermie

DE asociat

 

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Tratament

Operaii: SCLEROTERAPIA

anterograd

retrograd LAPAROSCOPICE ligatura/clipare vene

spermatice în segmentul iliac CLASICE:

IVANISSIEVICH PALOMO

MICROCHIRURGICALE ± anastomozavenei spermatice la vena epigastric inf.

 

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Cura laparoscopic a varicocelului

incizia peritoneuluiizolarea

veneispermatice

inspecia local

pulsaiile arterei

vene restante

 

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Cura laparoscopic a varicocelului

Cliparea venei controlul hemostazei

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