超声引导精索阻滞下F4.8可视肾镜治疗附睾良性肿物的疗效分析

Efficacy analysis of F4.8 visual nephroscope under ultrasound-guided spermatic cord block in the treatment of benign epididymal tumors

目的评估在超声引导精索阻滞下,应用F4.8可视肾镜治疗附睾良性肿物的疗效及安全性。方法选取82例附睾肿物患者,采用随机数字表法分为盲探穿刺组和超声引导穿刺组,每组41例。所有患者均应用F4.8可视肾镜作为阴囊镜施行手术。盲探穿刺组于腹股沟管外环处盲探穿刺进行精索阻滞;超声引导穿刺组利用彩色多普勒超声诊断仪完成精索阻滞。记录患者的手术时间、围手术期并发症、精索阻滞成功率、血管性并发症、术中麻醉性药物追加以及麻醉方式更改情况。采用视觉模拟评分(VAS)对患者进行疼痛评估,并对患者进行随访。结果 64例附睾囊肿患者均予镜下钬激光囊肿去顶术;18例附睾实性肿物患者镜下确诊为附睾附件不全扭转,予钬激光切除。与盲探穿刺组相比,超声引导穿刺组的精索阻滞成功率更高,血管性并发症发生率、麻醉方式更改率更低(P<0.05),2组术中麻醉性药物追加率差异无统计学意义。超声引导穿刺组在手术5 min、术后2 h的VAS和住院费用低于盲探穿刺组(P<0.05),术后6 h、12 h VAS,住院时间2组差异无统计学意义。随访患者术后1个月、3个月及12个月复查阴囊彩超,未见患侧睾丸、附睾及精索异常。结论超声引导精索阻滞下F4.8可视肾镜治疗附睾肿物安全有效,可作为理想的检查、治疗方法,具有较好的应用价值。

Objective To evaluate the safety and efficacy of F4.8 visual nephroscope in the diagnosis and treatment of epididymal benign mass under ultrasound-guided spermatic cord block.Methods A total of 82 patients with epididymal masses were randomly divided into the blind puncture group and the ultrasound-guided puncture group,with 41 cases in each group.All patients underwent scrotal surgery with F4.8 visual nephroscope.In the blind puncture group,spermatic cord block was performed by blind puncture at the outer ring of inguinal canal.The ultrasound-guided puncture group completed spermatic cord block with color doppler ultrasound diagnostic instrument.The operation condition,perioperative complications,success rate of spermatic cord block,vascular complications,addition of anesthetic drugs during operation and change of anesthesia mode were recorded.Visual analogue scale(VAS) was used to evaluate the pain after operation,and the patients were followed up.Results The total of 64 patients with epididymal cysts underwent endoscopic holmium laser capsulotomy.Eighteen patients with solid tumors of epididymis were diagnosed as incomplete torsion of epididymal appendages under microscope and underwent holmium laser resection.Compared with the blind puncture group,the success rate of spermatic cord block was higher,the incidence of vascular complications and the change rate of anesthesia mode were lower in the ultrasound-guided group(P<0.05).There was no significant difference in the addition rate of narcotic drugs between the two groups.The VAS at 5 min and 2 h after operation and the total cost of hospitalization were lower in the ultrasound-guided group than those in the blind puncture group(P<0.05).There were no significant differences in 6 h VAS and 12 h VAS after operation and hospital stay between the two groups.The patients were followed up 1 month,3 months and12 months after operation.No abnormality was found in testis,epididymis and spermatic cord.Conclusion The technique of F4.8 visual nephroscope under ultrasound-guided spermatic cord block is safe and effective in the treatment of epididymal benign mass.It can be used as an ideal inspection and treatment method,and it is worth promoting.