[intro-text]Повторная операция при варикоцеле проводиться в случае рецидива заболевания. Если лечение проводилось в подростковом возрасте, то риск вторичного варикоцеле составляет 20-40%, проводимое хирургическое вмешательство у взрослых, снижает данный показатель до 9%. По этой причине, при появлении заболевания в юном возрасте, врачи советуют подождать, если есть такая возможность, до совершеннолетия.
Повторный недуг развивается довольно медленно. Его первые признаки могут появиться спустя год после операции. Лечится он оперативным методом. Желательно повторно обратиться к тому специалисту, который проводил первую операцию. Крайне редко патология возвращается в третий раз.[/intro-text]
[contents]
Почему возникает потребность в повторной операции?
Все зависит от особенностей мужского здоровья и от качества проведенного лечения. Недуг может вернуться к уже прооперированной стороне, а может поразить здоровую. К главным причинам рецидива относят:
- особое строение вен и артерий, которые пациент имеет с рождения;
- отсутствие клапанов;
- наличие болезней сердечно-сосудистой системы;
- имеющиеся дублирующиеся вены;
- наследственные факторы;
- образование застойных процессов вследствие замедленного кровотока;
- некачественное проведение первой операции;
- слабые стенки вен.
Иногда у пациента в недостаточной степени распространяется вещество при проведении склерозирования.
Как проявляется повторное заболевание?
Существенной разницы в симптомах первичного и вторичного варикоцеле нет. Оно также протекает спокойно, без ярко выраженных специфических симптомов.
Об образовании повторного варикоцеле могут говорить боли в паху после длительных пеших прогулок или другой физической нагрузки. Также может появляться ощущение тяжести после интимной близости. В некоторых случаях мошонка увеличивается в размере. Если длительное время не обращаться к врачу, то образуются регулярные боли тянущего характера. Обычно именно в этот период больной спешит к специалисту.
[frame-icon type=»5″ color=»red»]Помните, что запущенные формы заболевания могут привести к необратимым последствиям, вплоть до бесплодия.[/frame-icon]
В каких случаях проводят повторную операцию?
Показанию к повторному оперативному лечению является варикоцеле 2 и 3 степени. Предварительно, в обязательном порядке, делают тест на бесплодие, так как главная цель операции сохранение фертильности у мужчины. Если у пациента уже развилось гипотрофия яичка или он не планирует больше становиться отцом, то могут не проводить оперативное вмешательство.
Длительность оперативного вмешательства при открытых хирургических манипуляциях составляет около часа, а при лапароскопии и эндоскопии — полчаса. Также на ее продолжительность влияет тяжесть развития варикоцеле.
Необходимые анализы
Чтобы создать четкую и максимально обширную картину перед операцией необходимо будет провести такие исследования, как;
- сдать анализы крови на СПИД, гепатит, сифилис;
- установить группу крови и ее резус;
- проверить биохимический состав и свертываемость крови;
- провести проверку сердца (ЭКГ) и УЗИ мошонки;
- сделать допплерометрию мошонки.
В редких случаях могут назначаться дополнительные обследования.
Методы проведения повторной операции
Обычно при рецидиве применяется оперативное лечение. Методики без операции актуальны только в том случае, если заболевание было обнаружено на ранней стадии. Существует несколько основных методов лечения, это:
Лапароскопия
Во время нее в брюшную полость пациента вводят специальный прибор стетоскоп. Лапароскопия проходит без осложнений, а реабилитационный период занимает короткий период. После лечения, во время восстановления, пациент практически не испытывает боли. Первые пару недель после хирургического вмешательства врачи рекомендуют воздерживаться от половой близости и физической деятельности. Большим преимуществом данной методики является то, что практически 50% больных, спустя год избавляются от бесплодия.
По теме: Полная информация о лапароскопической операции
Методика Иваниссевича
Это популярный способ борьбы с повторным варикоцеле, но в отличие от первого он имеет ряд недостатков. Сюда входит повреждение артерий, осложнения, слабая эффективность. Проходит операция под местной анестезией, у детей — под общим наркозом. Противопоказаниями к данному виду хирургического вмешательства относиться тяжелое общее состояние пациента и наличие нарушения свертываемости крови.
По теме: Полная информация об операции Иваниссевича
Операция Мармара
У данной методики практически нет осложнений, у пациента на теле не остается некрасивых рубцов. Восстановление происходит за короткий срок. Дополнительно перед операцией может потребоваться исследование на уровень гормонов и спермограмма.
Проводиться оперативное вмешательство под местной анестезией. Хирург делает маленький разрез в области паха, и после разрезая каждый слой, постепенно добирается до канала с пораженной веной. Операция проводиться быстро и во время нее пациент не испытывает боли.
По теме: Полная информация об операции Мармара
Микрохирургическая перевязка
Это усовершенствованный способ методики Иваниссевича. Здесь более часто достигается положительный результат и практически полностью отсутствуют осложнения. В этом варианте лечения заболевания имеется риск повреждения артерии. Проведение операции занимает довольно длительное время.
Шунтирование
Во время данной методики лечения создают специальный шунт, по нем формируют обходной кровоток из яичек. Семенная вена соединяется с сосудами подвздошного, эпигастрального отделов или на бедре. Минусом шунтирования является то, что имеется высокий риск образования тромбов.
Склерозирование
Это хирургическое вмешательство является закрытым. Во время него в расширенную вену ангиографическим способом вводятся склерозирующие вещества. Когда они попадают в организм происходит склеивание сосудов. Применяется на практике данная методика лечения довольно редко. Подходит всем представителям мужского пола вне зависимости от возраста.
При склеротерапии госпитализация не нужна. В тот же день, после операции, пациент может вернуться домой. Единственное, что данный метод лечения применяется при начальной стадии заболевания. В остальных случаях варикоцеле может развиться вновь.
Чрескожная эмболизация
Проводиться оно довольно редко, так как имеет высокий риск осложнений. Проводиться она через проколы, ткани при этом не разрезаются. Ее недостаток заключается в том, что возможно появление венозного рубцевания. Оно может перекрыть кровоток в клетки яичек.
Микрохирургическая антеградная склеротерапия
Это довольно эффективная методика лечения. Она относиться к комбинированному типу. После ее проведения 97% пациентов избавляются от повторного варикоцеле. Во время операции происходит минимальное повреждение тканей. Недостатком методики является длительность проведения и то, что пациент подвергается воздействию рентгеновских лучей.
Какие осложнения могут возникнуть после операции?
В основном операции проходят без осложнений. В редких случаях возможно:
- Отек мошонки. Отечность может наблюдаться как с одной стороны, так и с обеих. Появляется она спустя некоторое время после операции. Чтобы избежать такого вида осложнение, врачи рекомендуют некоторое время носить специальную поддерживающую повязку.
- Боль в районе мошонки. Их устраняют при помощи противовоспалительных и обеззараживающих препаратов.
- Появление гидроцеле. Это накопление жидкости в мошонке. Появляется данное осложнение практически у половины пациентов. Она практически всегда проходит самостоятельно спустя 8-10 месяцев.
- Образование гипотрофии или атрофии яичек. Случается данное осложнение довольно редко.
Также могут наблюдаться осложнения в зависимости от метода проведенного лечения. Например, аллергическая реакция возникает после эндоваскулярной терапии. Организм негативно может среагировать на введенный препарат. После лапароскопии возможно кровотечение. Также к осложнениям лапароскопической операции относиться отхождение клипсы или не полный захват вены.
Обязательно следует обратиться к врачу, если поднялась температура, появилась острая боль, из раны идет гной. Небольшие осложнения со временем проходят самостоятельно.
Наилучшим вариантом для проведения повторной операции является микрохирургический метод вмешательства. Он является более сложным, но дает положительный результат.
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