[intro-text]Варикоцеле или расширение вен семенного канатика и яичек диагностируют у каждого седьмого мужчины. Нередко патология развивается еще в подростковом возрасте. Почему она возникает и как проявляется – должен знать каждый.[/intro-text]
[contents]
Механизм развития
За кровоснабжение яичек отвечают артерии и вены. Артериальные сосуды имеют упругие стенки. По ним обогащенная кислородом кровь поступает к тестикулам. От них обратно к сердцу она возвращается по венам. Собираясь в лозовидное сплетение, они превращаются в семенную вену и впадают: в нижнюю полую вену – справа, в левую почечную вену – слева.
По сравнению с артериальными, стенки венозных сосудов менее эластичны. Ток крови по ним регулируют двустворчатые клапаны: они не дают ей возвращаться обратно в яички. Варикоцеле развивается, когда работа клапанной системы нарушается: в почечной и семенных венах возникает противоток. Это приводит к повышению давления в сосудах, их расширению, формированию опухолевидных венозных узлов.
Классификация варикоцеле
В зависимости от особенностей развития варикоцеле делят на виды.
| Критерий, согласно которому проводится классификация варикоцеле | Виды варикозного расширения вен семенного канатика |
| Сторона поражения | Правостороннее |
| Левостороннее | |
| Двустороннее | |
| Механизм возникновения | Первичное (врожденное или приобретенное) |
| Вторичное | |
| Характер венозного рефлюкса | С ренотестикулярным рефлюксом |
| С иелотестикулярным рефлюксом | |
| С рефлюксом смешанного типа | |
| Определимость с помощью физикальных методов | Клиническое |
| Субклиническое | |
| Наличие гипертензии в почечной вене | С синдромом гипертензии в почечной вене и без него |
[frame-text-border]Чаще всего диагностируют левостороннее варикоцеле: это связано с особенностями строения яичковых вен. Двустороннюю патологию обнаруживают у 2-12% больных, еще реже правостороннюю – в 3-8% случаях.[/frame-text-border]
Причины возникновения
Причины возникновения варикоцеле могут быть разными. К факторам, способствующим его развитию в подростковом и взрослом возрасте, относятся:
- Генетическая предрасположенность к варикозному расширению вен. Проявляется в виде слабости стенок сосудов, недостатке соединительной ткани. Первый фактор приводит к постепенному растяжению вен, второй – становится причиной недоразвития венозных клапанов и обратного тока крови к яичкам, деформации вен. Чаще всего у больных варикоцеле с генетической предрасположенностью или у их родственников есть варикозная болезнь нижних конечностей, недостаточность сердечного клапана, другие патологии сердечно-сосудистой системы.
- Злокачественные, доброкачественные образования в брюшной полости, забрюшинном пространстве, органах малого таза (почках, мочевом пузыре) – причина вторичного варикоцеле. Развивающееся новообразование сдавливает вены лозовидного сплетения, провоцируя нарушения кровообращения.
- Хроническое расстройство стула. Постоянные натуживания при запоре или частая дефекация становится причиной хронического усиленного тока крови к органам малого таза и повышения нагрузки на вены.
- Уменьшение просвета яичковых вен, вызванное их перегибом, неправильным анатомическим расположением – одна из причин роста давления в сосудах и растяжения их стенок.
- Выполнение работы, связанной с поднятием тяжестей – сопровождается сильным напряжением мышц спины, брюшной полости, ног. Это ведет к интенсивному приливу крови к нижней части тела, увеличению давления в венах.
- Нерегулярная половая жизнь – провоцирует появление застойных явлений в малом тазу и может стать косвенной причиной варикозного расширения яичковых, семенных вен.
- Воспалительные заболевания органов мочеполовой системы хронической формы – часто приводят к возникновению спаечных процессов в малом тазу и рубцеванию его тканей. Спайки и рубцы могут стать причиной ущемления яичковой вены, повышения сосудистого давления и как следствие – появления варикоцеле.
- Чрезмерные физические нагрузки (силовые и кардиотренировки), регулярное выполнение упражнений, рассчитанных на накачивание брюшного пресса – приводят к повышению давления в сосудах, растяжению их стенок.
- Избыточная масса тела. При наличии лишнего веса повышается нагрузка на организм (а соответственно и на сосуды), существует риск сдавливания артерий и вен малого таза большим слоем жировой ткани: это может привести к повышению в них давления, их расширению.
- Врожденное ущемление сосудов почки. Левая почечная вена, подходя к нижней полой, располагается между аортой и верхней брыжеечной артерией. Когда она сдавлена, возникает венная почечная гипертензия: отток крови по яичковой вене затрудняется.
- Травмы мошонки: удар, ушиб, разрыв.
[frame-icon type=»6″ color=»blue»]Развитие варикоцеле в подростковом возрасте связано с усиленным развитием всех органов и систем организма. В этот период нагрузка на вены повышается. При наличии провоцирующих факторов (чаще всего это – занятия тяжелой атлетикой, бодибилдингом) работа их клапанов нарушается, а сами сосуды – расширяются.[/frame-icon]
Варикоцеле у маленьких детей и новорожденных
Варикозное расширение яичковых и семенных вен чаще всего возникает в период полового созревания. Но иногда патологию выявляют и у детей младшего возраста, грудничков.
Причинами развития варикоцеле у маленьких детей и новорожденных могут быть:
- слабость стенок венозных сосудов, брюшной стенки;
- нарушение внутриутробного развития на этапе формирования органов мочеполовой системы;
- отсутствие венозных клапанов;
- инфекционные заболевания женщины в период беременности (могут повлиять на формирование и развитие плода);
- наследственная предрасположенность;
- получение беременной женщиной травмы живота;
- тазовое предлежание плода.
[frame-icon type=»1″ color=»yellow»]Частота диагностирования варикоцеле в возрасте от 12 до 17 лет – 10-16%, до 11 лет – 6%. В 90-95% детей выявляют левостороннее поражение семенных вен. Правосторонняя патология в детском возрасте встречается в 2% случаях. Около 8-10% детей имеют двустороннее варикоцеле.[/frame-icon]
Симптомы
Клиническое проявление варикоцеле зависит от стадии его развития.
| Симптомы | Стадия варикоцеле |
| Отсутствуют | Первая |
| Вторая | |
| Дискомфорт, повышенное потоотделение, жжение в области паха | Третья |
| Опущение яичка на стороне поражения | |
| Боль в мошонке | |
| Четвертая | |
| Выраженный венозный рисунок в паху | |
| Увеличение, асимметрия мошонки |
Болевые ощущения в яичках на третьей стадии варикоцеле имеют тупой и ноющий характер. Они умеренные, возникают периодически – во время ходьбы, полового акта, физических нагрузок. Боли усиливаются после длительных прогулок пешком:
[frame-text-big]Долгое время не обращал внимания на тянущие боли в паху. Чаще всего они возникали после тяжелых физических нагрузок. Возможно, так продолжалось бы и дальше, но жена заставила обратиться к врачу. Прошел УЗИ. Оказалось, причина болевых ощущений – левостороннее варикоцеле.
Тимур
[/frame-text-big]
Дискомфорт исчезает в положении лежа, при поднятии мошонки, ношении бандажей или белья, поддерживающих яички.
На четвертой стадии варикоцеле интенсивность болевого синдрома возрастает: беспокоят острые, напоминающие невралгию болевые ощущения в яичках. Они присутствуют постоянно и не зависят от физических нагрузок. Боли могут иррадиировать в низ живота, поясницу, ногу, зону промежности и в редких случаях – в половой член:
[frame-text-big]«В 2014 году беспокоили боли внизу живота. Обратился в местную больницу. Уролог не счел нужным делать УЗИ, а просто диагностировал простатит и назначил лечение. Поехал к другому доктору – в частную поликлинику. Там мне провели ультразвуковое исследование яичек и обнаружили двустороннее варикоцеле.
Владимир
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Помимо болевого синдрома, по мере развития варикоцеле появляются такие симптомы:
- расстройства мочеиспускания;
- слабость;
- быстрая утомляемость;
- ухудшение аппетита;
- снижение массы тела;
- повышенная раздражительность;
- нарушение репродуктивной функции.
[frame-icon type=»1″ color=»blue»]Симптомы варикоцеле на последних этапах его развития напоминает клиническое проявление других заболеваний органов мочеполовой системы. Иногда патологи сочетаются друг с другом. Поставить правильный диагноз способен только врач.[/frame-icon]
[frame-text-big]Обратился к урологу, когда начали беспокоить боли в яичках, паху и внизу живота. Результаты диагностики показали наличие левостороннего варикоцеле. Операцию врач не назначал: сказал, что нужно выяснить точную причину такой локализации болевого синдрома, а потом думать об оперативном вмешательстве.
Максим
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Методы лечения
Единственный эффективный метод борьбы с варикоцеле – оперативное вмешательство. Но тактика лечения зависит от выраженности симптомов патологии. На первых этапах ее развития, при отсутствии ярко выраженных признаков операцию проводить не обязательно. В таких случаях за течением заболевания наблюдают, а больным рекомендуют принятие мер, направленных на улучшение кровотока в яичках:
- применение медикаментозных средств;
- ношение белья, поддерживающего яички;
- занятия лечебной физкультурой;
- массаж яичек.
К хирургическому вмешательству обычно прибегают на третьей и четвертой стадии варикоцеле, при наличии таких показаний:
- болевой синдром высокой интенсивности;
- бесплодие;
- эстетический дефект мошонки;
- уменьшение размеров, атрофия яичка.
Существует около 120 способов оперативного лечения варикоцеле. Чаще всего проводятся такие операции:
- Эндоваскулярное склерозирование – введение в пораженную яичковую вену вещества, вызывающего ее облитерацию. Рекомендуется при наличии противопоказаний к хирургическим вмешательствам других видов.
- Микрохирургическая варикоцелэктомия – позволяет сразу же восстановить кровообращение в мошонке. Проводится при сильно измененной спермограмме, выраженных болях в паху. Ее эффективность – 95-98%.
- Лапароскопическая – малоинвазивное хирургическое вмешательство, суть которого заключается в перевязывании варикозно расширенной вены. Осуществляется лапароскопом через проколы в области пупка. Эффективна в 85-90% случаях.
- Иваниссевича – операция открытого типа. Проста в исполнении, проводится на любой стадии варикоцеле, но требует длительной реабилитации.
[frame-icon type=»5″ color=»red»]Все методики хирургического лечения варикоцеле достаточно эффективны. Но их проведение всегда связано с риском возникновения таких послеоперационных осложнений: боли в мошонке, занесение инфекции, водянка или атрофия яичка, повреждение артерий и лимфатических сосудов.[/frame-icon]
[frame-text-big]При прохождении профилактического осмотра уролог обнаружил варикоцеле 3 степени и посоветовал обратиться к хирургу. Долго сомневался по поводу операции и не зря: во время нее занесли инфекцию. Потребовалось повторное хирургическое вмешательство и долгая реабилитация.
Артур
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Длительное течение варикоцеле не только снижает качество жизни, но и может негативно сказаться на способности мужчины зачать ребенка. При проявлении его признаков важно сразу обратиться к врачу: чем раньше будет найдена причина его развития и начато лечение, тем ниже риск развития осложнений патологии.
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