过去，只有当女性伴侣出现可自然受孕的可治疗性不育时才建议进行精索静脉曲张修复术；然而，现在一些患者也可以接受修复术，即使夫妇因可能改善妊娠和活产儿结局而计划使用辅助生殖技术。[45]Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl. 2016;18:254-258.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4770495/http://www.ncbi.nlm.nih.gov/pubmed/26510504?tool=bestpractice.com
尽管只有一小部分患者有明显疼痛，纠正精索静脉曲张对缓解症状有较高的缓解率。[1]Nguyen HT. Hernia, hydroceles, testicular torsion, and varicocele. In: Docimo SG, Canning DA, Khoury AE, eds. Clinical pediatric urology. London, UK: Informa Healthcare; 2007.当精液分析结果异常时，应给予精索静脉曲张修复术。[25]Jarow JP, Sharlip ID, Belker AM, et al. Best practice policies for male infertility. J Urol. 2002;167:2138-2144.http://www.ncbi.nlm.nih.gov/pubmed/11956464?tool=bestpractice.com[26]American Urological Association; American Society for Reproductive Medicine. Report on varicocele and infertility. April 2001. http://www.auanet.org (last accessed 25 October 2016).http://www.auanet.org/common/pdf/education/clinical-guidance/Varicocele-Archive.pdf
手术技术包括开放手术，腹腔镜手术和经皮栓塞。既往有腹股沟手术史，腹股沟管下显微手术方式可能是保证保存睾丸动脉避免睾丸萎缩的最佳方案。[40]Al-Said S, Al-Naimi A, Al-Ansari A, Y, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180:266-270.http://www.ncbi.nlm.nih.gov/pubmed/18499176?tool=bestpractice.com一项meta分析结果显示显微外科结扎手术相比经皮或开放的非显微手术方法在复发率和并发症方面具有小但确实绝对的优势。[42]Ding H, Tian J, Du W, et al. Open non-microsurgical, laparoscopic or open microsurgical varicocelectomy for male infertility: a meta-analysis of randomized controlled trials. BJU Int. 2012;110:1536-1542.http://www.ncbi.nlm.nih.gov/pubmed/22642226?tool=bestpractice.com精索静脉曲张的治疗能够完全消除超过90%的精索静脉曲张。[25]Jarow JP, Sharlip ID, Belker AM, et al. Best practice policies for male infertility. J Urol. 2002;167:2138-2144.http://www.ncbi.nlm.nih.gov/pubmed/11956464?tool=bestpractice.com
一项评价开放手术治疗精索静脉曲张的研究结果表明，超过60%的男性精液参数改善，并且在试图怀孕的夫妻中有40%的妊娠率。[10]Dubin L, Amelar RD. Etiologic factors in 1294 consecutive cases of male infertility. Fertil Steril. 1971;22:469-474.http://www.ncbi.nlm.nih.gov/pubmed/4398669?tool=bestpractice.com[46]Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. A critical analysis. Urol Clin North Am. 1994;21:517-529.http://www.ncbi.nlm.nih.gov/pubmed/8059505?tool=bestpractice.com然而精索静脉曲张结扎手术是有争议的，一项严格排除亚临床型精索静脉曲张和精液参数正常男性的meta分析结果显示手术改善了精索静脉曲张和精液参数异常患者的精液参数。男性患有精索静脉曲张的夫妻妊娠率也有所提高。[3]Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. 2003;361:1849-1852.http://www.ncbi.nlm.nih.gov/pubmed/12788571?tool=bestpractice.com[38]Kroese AC, de Lange NM, Collins J, et al. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2012;(10):CD000479.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000479.pub5/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23076888?tool=bestpractice.com[47]Marmar JL, Agarwal A, Prabakaran S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88:639-648.http://www.ncbi.nlm.nih.gov/pubmed/17434508?tool=bestpractice.com[48]Agarwal A, Deepinder F, Cocuzza M, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007;70:532-538.http://www.ncbi.nlm.nih.gov/pubmed/17905111?tool=bestpractice.com在手术治疗后39%患有精索静脉曲张的无精子症患者精液中会出现精子。[50]Weedin JW, Khera M, Lipshultz LI. Varicocele repair in patients with nonobstructive azoospermia: a meta-analysis. J Urol. 2010;183:2309-2315.http://www.ncbi.nlm.nih.gov/pubmed/20400156?tool=bestpractice.com
