曾振华　唐建生　王栋洋　郑宏　彭林艳　王建　陈泮　游鹏

[摘要] 目的 探討阴囊镜手术治疗附睾肿块的临床效果。 方法 选取2016年1月至2018年6月期间在湘南学院附属医院住院的附睾肿块患者60例，根据不同手术方式分为两组，微创组（阴囊镜）30例（实际29例，1例因肿块粘连重改开放手术），使用阴囊镜下等离子电切术治疗。开放组30例，使用传统开放手术治疗。比较分析两组切口长度、手术时间、术中出血、术后住院时间、切口感染、阴囊水肿、术前术后阴囊疼痛评分指标。 结果 两组均顺利完成手术。微创组1例因肿块粘连改开放手术。两组均未发生睾丸输精管损伤、阴囊血肿。微创组无切口感染，开放发生组2例发生切口感染（6.67%），经换药、更换抗生素后治愈出院，术后随访均未见肿块复发两组术中出血量比较，差异无统计学意义（P>0.05）;微创组切口长度、手术时间、术后住院时间均低于开放组，差异有统计学意义（P<0.05）;微创组阴囊水肿发生率高于开放组，差异有统计学意义（P<0.05）。两头阴囊疼痛评分术前与术后1个月比较，差异无统计学意义（P>0.05），术后3个月微创组低于开放组，差异有统计学意义（P<0.05）。 结论 开放手术和阴囊镜下微创手术都能够治疗附睾肿块，但阴囊镜下手术具有创伤小、恢复快、住院和手术时间短、术后阴囊疼痛轻等优点，值得临床推广。

[关键词] 阴囊镜;开放手术;附睾肿块;疗效评价

[中图分类号] R698.2          [文献标识码] B          [文章编号] 1673-9701（2021）04-0050-04

Therapeutic efficacy of scrotal endoscopic surgery on epididymal mass

ZENG Zhenhua1   TANG Jiansheng1   WANG Dongyang1   ZHENG Hong1   PENG Linyan1   WANG Jian1   CHEN Pan1   YOU Peng2

1.Department of Urology Surgery， Affiliated Hospital of Xiangnan University， Chenzhou   423000， China; 2.Department of Dermatology and STD， the Maternal and Child Health Care Hospital of Xiangtan City in Hunan Province， Xiangtan 411100， China

[Abstract] Objective To explore the clinical efficacy of scrotal endoscopic surgery on epididymal mass. Methods A total of 60 patients with epididymal mass admitted to Affiliated Hospital of Xiangnan University from January 2016 to June 2018 were selected and divided into two groups according to different surgical methods. 30 patients（actual n=29， 1 patient was changed to open surgery due to adhesion of mass） were included in the minimally invasive group（scrotal endoscopy）， which was treated with plasma electro-resection under scrotal endoscopy. Others included in the open group（n=30） were treated with conventional open surgery. The incision length，operation time，intraoperative hemorrhage， postoperative hospitalization time， incision infection，scrotal edema and preoperative and postoperative scrotal pain score were compared and analyzed between the two groups. Results The operations were successfully completed in both groups. In the minimally invasive group，1 case was changed to open surgery due to adhesion of mass. No testicular or vas deferens injury and scrotal hematoma occurred in the two groups. There was no wound infection in the minimally invasive group， and 2 cases in the open group（6.67%）， which were cured and discharged after changing the dressing and antibiotics. There was no relapse of mass in the follow-up after operation. The data comparison between the two groups showed that there was no significant difference in intraoperative hemorrhage（P>0.05）. The incision length， operation time and postoperative hospitalization time in the minimally invasive group were lower than those in the open group， and the differences were statistically significant（P<0.05）. The incidence of scrotal edema in the minimally invasive group was higher than that in the open group， and the difference was statistically significant（P<0.05）. Scrotal pain score of before operation and after 1rd month， the difference was not statictically significant（P>0.05）， and it was lower in the minimally invasive group than in the open group at 3rd month after operation， with statistically significant differences（P<0.05）. Conclusion Both the open surgery and minimally invasive surgery under scrotal endoscopy can treat epididymal mass， but scrotum surgery has the advantages of less trauma， rapid recovery， short hospitalization and operation time， and less postoperative scrotal pain， which is worthy of clinical promotion.

[Key words] Scrotal endoscopy; Open surgery; Epididymal mass; Efficacy evaluation

附睾肿块是一类临床上不太引起重视的生殖系统疾病，好发于青壮年，临床上无特异性症状[1]。这类疾病如不积极治疗，不仅会给患者的生活带来痛苦，还可能影响患者的生育能力和性生活[2]。目前治疗附睾肿块的主要方法，如肿块小，跟踪观察不做处理，如肿块大则手术切除。传统的手术方式是切开阴囊将肿块完整切除。近年来随着腔镜外科的发展，产生一种微创手术方式——阴囊镜下附睾肿块电切除术。为探……