阴囊镜在附睾肿块治疗中的应用

Surgical Treatment of Epididymal Mass with Scrotoscope

目的探讨阴囊镜等离子电切术在附睾肿块诊治中的安全性和应用价值。方法系统性回顾我院2016年11月～2018年8月收治的15例附睾肿块患者的临床资料,其中囊性肿块(附睾囊肿)10例,采用等离子电切去顶术治疗;实性肿块5例,采用等离子电切除术治疗。结果本组15例患者手术均获成功,无中转开放手术,无睾丸输精管损伤、阴囊血肿、伤口感染等并发症。囊肿手术时间平均18(15～25)min;实性肿块手术时间平均28(20～45)min;术中出血3～10 ml。术中证实囊肿10例(清亮囊液4例,乳白色精液样囊液4例,淡黄色囊液2例);实性肿块5例,单纯附睾肿块切除4例,肿块及部分附睾一并切除1例。术后病理示:慢性炎症3例,附睾囊肿10例,附睾结核1例,精子肉芽肿1例。术后无严重阴囊水肿,仅有轻～中度阴囊皮下水肿,术后1～3 d消退,2～4 d痊愈出院。术后随访1～6个月,所有患者阴囊疼痛消失,无睾丸萎缩、鞘膜积液等,未见肿块复发。结论阴囊镜等离子电切术治疗附睾肿块安全、有效,具有创伤小、恢复快、手术和住院时间短、并发症少等优点。

Objective To investigate the safety and application value of scrotoscopic plasma electrotomy in the diagnosis and treatment of epididymal masses. Method The clinical data of 15 cases with epididymal masses admitted to our hospital from November 2016 to August 2018 were analyzed retrospectively, including 10 of cystic mass(epididymal cysts) treated by plasma electric unroofing and 5 of solid masse treated by plasma electrotomy. Results All surgical interventions were succeed in the 15 patients without conversion to open surgery. There were no complications as injury of testis and deferens, scrotal hematoma, wound infection and others. The mean operative time was 18(15~25) minutes of cyst and 28(20~45) min of solid mass. The intraoperative bleeding ranged from 3 to 10 ml. The cysts were confirmed in 10 cases(clear cyst fluid in 4, milky semen-like cyst fluid in 4 and pale yellow cyst fluid in 2), solid mass in 5 cases(performed simple mass excision in 4 and mass and partial epididymectomy in 1). The postoperative pathology showed chronic inflammation in 3 cases, epididymal cyst in 10 cases, epididymal tuberculosis in 1 case and sperm granuloma in 1 case. There was no severe scrotal edema, only mild to moderate scrotal subcutaneous edema and improved during 1 to 3 days after the operation. After 1 to 6 months follow-up, the scrotal pain disappeared, and no testicular atrophy, hydrocele and mass recurrence was found. Conclusion Scrotoscopic plasma electrotomy is a minimally invasive, safe and effective method for epididymal masses with the advantages of fewer traumas, faster recovery, shorter operation and hospitalization time and fewer complications.