Варикоцеле

Причины развития и симптоматика варикоцеле

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14 мая 2018

[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.

Классическое варикоцеле левого яичка.

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.
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[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.

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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.
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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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