Name: microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst
Uploaded: 2023-03-31T13:20:00
Description: Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

本研究得到了云南省卫生科技项目（编号：2018NS0256）和云南省医学学科带头人培训对象（编号：D-2018039）的支持。

我们对昆明工业大学附属医院（云南省第一人民医院）泌尿科住院科收治的男性患者的临床资料进行了回顾性分析。手术前必须获得患者的书面知情同意。
1. 临床纳入和排除标准
<ol><li>包括 45 岁以下且需要保持生育能力的患者。 注意：本研究中的患者年龄小于45岁。</li>
	<li>包括临床医生在接受 B 型超声或计算机断层扫描 （CT） 成像后初步诊断为附睾囊性占...

<ol>
	<li>Jelloul, L., Billerey, C., Ait Ali Slimane, M., Mboyo, A., Aubert, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cysts+in+adolescents.">Epididymal cysts in adolescents.</a> Annales d'Urologie. 33 (2), 104-108 (1999).</li><li>Boscarelli, A., Bellini, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epididymal+cyst+in+children.">Epididymal cyst in children.</a> European Journal of Pediatrics. 180 (9), 2723-2729 (2021).</li><li>Yong-Bao, W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+and+safety+of+scrotoscope+in+the+treatment+of+masses+in+caput+epididymidis.">The efficacy and safety of scrotoscope in the treatment of masses in caput epididymidis.</a> Journal of Trauma and Emergency Surgery. 6 (4), 208-211 (2018).</li><li>Erikci, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Management+of+epididymal+cysts+in+childhood.">Management of epididymal cysts in childhood.</a> Journal of Pediatric Surgery. 48 (10), 2153-2156 (2013).</li><li>Zhen-Chao, L., Xing-You, Q., Rong-De, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnosis+value+of+high+frequency+color+doppler+ultrasound+for+epididymis+cyst.">Diagnosis value of high frequency color doppler ultrasound for epididymis cyst.</a> China Modern Medicine. 20 (3), 102-103 (2013).</li><li>Sinha, V., Shankar, M., Sardana, N., Aggarwal, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+rare+case+of+epididymal+cyst+due+to+schistosomiasis.">A rare case of epididymal cyst due to schistosomiasis.</a> Cureus. 11 (9), e5755 (2019).</li><li>Mukendi, A. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+spontaneous+resolution.">Bilateral spontaneous resolution.</a> Clinical Case Reports. 8 (12), 2689-2691 (2020).</li><li>Patoulias, D., Kalogirou, M., Patoulias, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intraparenchymal+4+cm+in+diameter+in+a+15-year+old+male+patient;+a+case+report+and+review+of+the+literature.">Intraparenchymal 4 cm in diameter in a 15-year old male patient; a case report and review of the literature.</a> Acta Medica. 59 (4), 137-139 (2016).</li><li>Sun-Biao, L., Meng, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+43+epididymal+mass+patients.">Clinical analysis of 43 epididymal mass patients.</a> Fujian Medical Journal. 31 (3), 32-33 (2009).</li><li>Wang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Treatment+for+childhood+herniorrhaphy.">Treatment for childhood herniorrhaphy.</a> Urology. 112, 80-84 (2018).</li><li>Ory, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+success+after+bilateral+during+vasectomy+reversal:+A+multi-institutional+analysis.">Predictors of success after bilateral during vasectomy reversal: A multi-institutional analysis.</a> Canadian Urological Association Journal. 16 (3), E132-E136 (2022).</li></ol>

正如我们之前提到的，附睾囊肿主要发生在 20 至 40 岁的男性中，同时也有一些关于儿童附睾囊肿的文献1，2。迄今为止，附睾囊肿的病因尚不清楚，也没有治疗其的特定药物。除了少数附睾囊肿无需手术即可自发消退的报道7外，大多数附睾囊肿虽然进展和增大相对较慢，但无法自行吸收和消除。虽然是良性病变，但大的附睾囊肿可引...

附睾囊肿主要发生在 20-40 岁的男性中，尽管也有一些关于儿童附睾囊肿的文献1，2。以前的报告涵盖了对非显微镜附睾囊肿切除术或附睾切除术患者的手术破坏和术后瘢痕形成的担忧3，4。其他术后复合体包括精道梗阻、免疫性不孕和睾丸萎缩。术后发生甚至复发血肿、水肿、持续疼痛和囊肿的风险也更高5，6。也有报道说，附睾囊肿无需手术即可自行消退7。因此，既往研究得出结论，附睾囊肿不会导致睾丸网络扩张，如果附睾囊肿与睾丸网络扩张或输精管近端损伤相结合，可以考虑穿刺或手术治疗2，4。此外，一些研究者认为，附睾囊肿大伴有疼痛的患者也适合手术切除8。仅通过穿刺治疗附睾囊肿容易复发。传统（非显微镜）囊肿切除术或附睾切除术可能破坏附睾管，导致附睾梗阻、免疫性不孕，甚至睾丸萎缩;因此，对于有生育能力要求的年轻患者应谨慎2，9。建议有分娩计划的患者选择传统的（非显微镜）附睾囊肿手术作为预防措施。
显微外科方法已广泛应用于输精管梗阻和附睾梗阻的治疗，效果优异10，11。通过微技术 治疗 男性附睾囊肿可能是一种有益的选择，但将微技术治疗扩展到男性附睾囊肿的必要性值得怀疑。在国内率先开展显微附睾探查和囊肿切除手术。我们对昆明工业大学附属医院（云南省第一人民医院）泌尿科住院科收治的最初诊断为附睾囊肿的男性患者的临床资料进行了回顾性分析。患者年龄小于45岁，需要保留生育能力。基于显微镜操作，这在很大程度上改善了附睾微妙组织结构的可视化，囊肿可以清楚地解剖并完全完整地切除。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Ablation electrode</td>
			<td>Baisheng Medical Devices Co., Ltd. China</td>
			<td>OBS-Db</td>
			<td></td>
		</tr>
		<tr>
			<td>Anesthesia apparatus</td>
			<td>Datex-Ohmeda,Inc.USA</td>
			<td>Aespire View, Datex-Ohmeda</td>
			<td></td>
		</tr>
		<tr>
			<td>Compact Anesthesia Monitor</td>
			<td>GE Healthcare Finland OY.Finland</td>
			<td>S/5 Compact</td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;Electric knife</td>
			<td>Valleylab.USA</td>
			<td>Valleylab Force FX-8C</td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical (operation) microscope</td>
			<td>Lecia Microsysterms (Schweiz) AG. Germany</td>
			<td>Lecia M525 F20</td>
			<td></td>
		</tr>
	</tbody>
</table>

microscopic cyst resection for the treatment of patients diagnosed with epididymal cyst

附睾囊肿多发生在20-40岁的男性中。以前的报告涵盖了对术后复合体的担忧，包括接受过非显微镜附睾囊肿切除术或附睾切除术的患者的术后水肿、血肿、持续疼痛和精道梗阻。作为预防措施，建议对有分娩计划的患者进行非显微镜附睾囊肿手术。通过微技术 治疗 男性附睾囊肿显然是一种有益的选择;在国内率先开展显微附睾探查和囊肿切除手术。从2017年9月至2021年4月，41名被诊断患有附睾囊肿的年轻和中年男性患者在一个名为“显微镜附睾探索和膀胱切除术”的项目中接受了微技术治疗。术后随访持续3-50个月。结果证实，由于显微镜操作在很大程度上改善了附睾细微组织结构的可视化，囊肿可以在显微镜下被清楚地解剖并完全完整地切除。手术期间出血显着减少（2-3mL），并且不需要伤口引流。随访数据显示，显微镜治疗显著降低了术后阴囊血肿、水肿、术后长期疼痛的发生率，有望提高手术成功率和预防复发。此外，初步经验和反思表明，显微镜附睾探查和膀胱切除术通过精细治疗可以有效地保持附睾通畅，同时可以达到更好的预后。我们建议在附睾囊肿发展到直径0.8cm之前进行手术，因为担心较大的附睾囊肿（直径>0.9cm）可能导致同侧附睾的所有小管完全破坏 - 睾丸输出网络受损的更严重病例。

从 2017 年 9 月到 2021 年 4 月，41 名被诊断为附睾囊肿的中青年男性患者在一个名为“显微镜附睾探索和膀胱切除术”的项目中接受了微技术治疗。
在这里，我们展示了来自单个患者的数据作为代表性示例。患者在全身麻醉下进行下行手术（睾丸和附睾探查和显微镜囊肿切除术）。做阴囊切口，切开睾丸鞘，探查阴囊，在显微镜下分离手术侧附睾。寻找附睾肿块（囊肿），并?...

Watch this Scientific Journal Video about Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst at JoVE.com

Microscopic Cyst Resection for the Treatment of Patients Diagnosed with Epididymal Cyst

在这里，我们提出了一种使用显微镜囊肿切除术治疗被诊断为附睾囊肿的患者的方案。基于显微镜操作，获得了附睾细微组织结构的大幅改善可视化，因此囊肿可以清楚地解剖并完全完整地切除。

显微镜囊肿切除术治疗诊断为附睾囊肿的患者

Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative ...

在这里，我们提出了一种使用显微镜囊肿切除术治疗被诊断为附睾囊肿的患者的方案。基于显微镜操作，获得了附睾的可视化，获得了细微的组织结构，从而能够准确解剖和完整切除。首先，在 6 倍至 10 倍的功率放大镜下检查附睾髓。使用电刀，切开附睾囊肿底部的附睾囊和正常附睾组织。小心打开附睾囊，避免打开附睾囊腔。沿囊肿壁微分离附睾囊肿后，小心分离附睾囊肿底部周围的附睾组织。然后将附睾囊肿与其底部以及其与正常附睾组织之间的间隙微分离。用微血管夹闭塞附睾组织或用7或6-0微缝合线结扎后，用显微剪刀或电刀从底部切除附睾囊肿。所代表的数据来自本研究中包括的41名患者。所有附睾囊肿在手术后30至50分钟内完全切除。手术期间的出血明显减少，不再需要伤口引流。术后随访持续3至50个月。评估了手术并发症，数据显示在此处。无患者附睾囊肿复发，术后无阴囊肿。只有一名患者出现阴囊手术部位疼痛。随访数据显示，显微镜治疗显著降低了术后阴囊血肿、水肿、术后长期疼痛的发生率，有望提高手术成功率和复发预防。执行此程序时，请仔细解剖分离物，避免附睾囊肿壁破裂，特别是在血液附睾囊肿或内部有透明囊液的大附睾囊肿上。

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