精索阻滞超声引导下F4.8可视肾镜在睾丸良性疾病中的临床应用

Application of 4.8Fr visual percutaneous nephrolithotomy for management of testicular benign diseases under ultrasound-guided spermatic cord block

目的评估在精索阻滞超声引导下F4.8可视肾镜作为“阴囊镜”在睾丸良性疾病诊断和治疗中的应用价值。方法回顾性分析2018年1月至2021年1月广州市番禺区何贤纪念医院收治的58例睾丸良性疾病的成年患者临床资料,年龄(42.7±10.4)岁,均采取精索阻滞麻醉超声引导下,应用F4.8可视肾镜作为“阴囊镜”施行手术。结果58例患者均成功实施阴囊镜手术,未出现血管损伤、睾丸破裂、阴囊血肿、附睾及精索损伤等并发症。32例睾丸鞘膜积液患者均予镜下钬激光鞘膜切除;18例慢性睾丸疼痛患者镜下确诊为睾丸(附睾)附件不全扭转8例,予镜下钬激光切除;8例怀疑睾丸扭转的患者中5例术中确诊睾丸扭转,另外3例确诊急性附睾炎。所有患者手术5 min的疼痛视觉模拟评分(3.8±1.8)分,其中4例患者(6.9%)改行静脉全身麻醉。3例患者(5.2%)术后伤口疼痛,6例(10.3%)术后阴囊壁轻度水肿,均予保守治疗后缓解,未出现阴囊切口感染等并发症,住院时间(4.9±1.4)d。随访患者术后1个月、3个月均接受阴囊彩超检查,提示患侧睾丸、附睾及精索未见异常。结论精索阻滞精准局部麻醉超声引导下应用F4.8可视肾镜诊治睾丸良性疾病,微创、简便、经济且安全有效,有较好的应用价值,值得推广。

Objective To explore the application of 4.8Fr visual percutaneous nephrolithotomy in the treatment of testicular benign diseases under ultrasound-guided spermatic cord block.Methods The clinical data of 58 adult patients with testicular benign diseases with an age of(42.7±10.4)years old in He Xian Memorial Affiliated Hospital of Southern Medical University from January 2018 to January 2021 were retrospectively analyzed.They all underwent scrotal surgery with 4.8Fr visual percutaneous nephrolithotomy under ultrasound-guided spermatic cord block.Results All patients were successfully performed scrotal cystoscopy without severe complications occurred,such as vascular injury,testicular rupture,scrotal hematoma,epididymis,or spermatic cord injury.Thirty-two cases of hydrocele testis accepted laser resection of the perididymis.Eight out of 18 cases of chronic testicular pain were diagnosed as incompletely torsion of the testicular or epididymis accessory,and underwent holmium laser resection.In 8 cases of suspected testicular torsion,the diagnosis was confirmed in 5 cases and the other 3 cases were diagnosed as acute epididymitis.The score of Visual Analogue Scale of all patients 5 minutes after the operation was(3.8±1.8)points,and 4 cases(6.9%)changed to venous general anesthesia.Three cases(5.2%)felt pain and 6 cases(10.3%)had mild oedema of the scrotum wall after the operation,which all eased after conservative treatment.No postoperative infection of scrotal incision occurred and the hospitalization time was(4.9±1.4)days.The scrotal ultrasonography was performed after 1 and 3 months,and no abnormal structure in testis,epididymis,or spermatic cord was observed.Conclusion The technique of 4.8Fr visual percutaneous nephrolithotomy under ultrasound-guided spermatic cord block could be an ideal inspection and treatment method for testicular benign diseases,is minimally invasive,simple,economical,safe,and effective,and is worth promoting.