一种新型阴囊镜的研制及临床应用研究  

The research on clinical application of a new scrotoscope

作　　者：苏新军[1] 程跃[1] 吴科荣[1] 方立[1] 罗春华[1] 

机构地区：[1]宁波大学医学院附属第一医院泌尿外科,浙江宁波315000

出　　处：《微创泌尿外科杂志》2013年第4期277-279,共3页Journal of Minimally Invasive Urology

摘　　要：目的:探讨一种新型阴囊镜的适用性、安全性及临床应用价值.方法:2011年6月~2013年5月,对23例慢性睾丸痛经非甾体抗炎药物保守治疗3~6个月,症状改善不明显患者在硬膜外麻醉下采用自行研制的新型阴囊镜进行阴囊镜检查,发现病灶后予取活检并使用200 μm光纤,1.2~1.5 J/15~20 Hz(18~30 W)功率钬激光汽化病灶.所有患者排除已知引起慢性睾丸疼痛原因,术前均以视觉模拟疼痛评分(VAS)评估疼痛程度.结果:本组23例患者均顺利置入阴囊镜,镜下发现疼痛侧睾丸鞘膜腔内存在附睾/睾丸附件,且附件蒂部长为0.5~1.5 cm,蒂根部扭转90~180°,部分充血、水肿;非疼痛侧睾丸及附睾表面未见睾丸及附睾附件,可见附睾表面充血.阴囊镜下用活检钳取出部分睾丸/附睾附件送病检,残端予用钬激光光纤汽化.手术时间45~90 min,平均52 min;术中有轻中度阴囊皮下水肿,术后1~3天水肿消退,无阴囊血肿、睾丸破裂等并发症;术后1个月门诊随访阴囊疼痛评分0~1分,平均0.3分;行B超复查双睾丸、附睾血流正常,未见异常回声,睾丸鞘膜腔内未见积液.术后病理显示纤维囊壁钙化或潴留囊肿组织.结论:新型阴囊镜临床适用简便、安全、有效、并发症少,临床可用于慢性睾丸疼痛的病因诊断并针对性治疗,是一种值得关注并进一步研究的新型微创诊疗设备.Objective:To investigate the feasibility,safety and clinical application value of a new home-made scro- toscopy.Methods:From June 2011 to May 2013,23 patients were enrolled in this study undergoing scrotoscopy for treatment of chronic orchialgia All patients had ever received non-steroid anti-inflammatory drug(NSAIDs)for 3-6 months while no fundamental efficacy was observed.After excluding other causes that may cause chronic orchialgia, scrotoscopy was performed under spinal anesthesia.The pain condition was evaluated through the VAS(visual ana- log score)before surgery.Holmium laser fiber(200μm,1.2-1.5J/15-20Hz,18-30W)was used to vaporize the le- sion(Operative time,complications as well as patients' recovery were recorded).Ultrasound test was performed and pain score was evaluated one month postoperatively.Results:The technique was successful in all 23 patients.All patients were found orchiepididymal appendages lesions in the affected side,with a length of 0.5-1.5cm and a torsion of 90-180 degrees.Congestion and edema were observed in some cases.While for the unaffected side,congestion of epididymis rather than orchiepididymal appendages was noticed.Operating forceps was used to get a biopsy of the lesion,and holmium laser fiber was inserted after biopsy to vaporize the lesion nub.The mean operative time was 52min(range form 45 to 90min). No hematoma or rupture of testis was found.The presence of mild or moderate scrotal edema was noticed during the opera- tion,while it could disappear in 1-3 days after the surgery.The mean pain score by VAS was 0.3(range from 0-1).In the postoperative ultrasound test,blood supply of testis was normal,and no hydrocele was detected.The pathological result showed fibrous capsule wall calcification or retention cyst.Conclusions:The new scrotoscopy represents an easy-performing, effective,safe surgery with a low complication rate.It can identify the etiology of chronic orchialgia and provide targeted treatments.It is worthwhile to apply and do research to the new facility.

关 键 词：慢性睾丸疼痛 睾丸附件 阴囊镜 

分 类 号：R697[医药卫生—泌尿科学]