Strom Kurt H, Levine Laurence A
Department of Urology, Rush University Medical Center, Chicago, Illinois, USA.
J Urol. 2008 Sep;180(3):949-53. doi: 10.1016/j.juro.2008.05.018. Epub 2008 Jul 17.
We assessed the long-term efficacy, complications and patient perceptions of microsurgical denervation of the spermatic cord in the treatment of chronic orchialgia.
Microsurgical denervation of the spermatic cord was performed on 95 testicular units in 79 men (mean age 40.3 years, mean duration of pain 62 months, 16 bilateral) for chronic orchialgia. Conservative management failed in all, and patients were evaluated with an extensive medical history and physical examination. To be a candidate for microsurgical denervation of the spermatic cord each man would have responded either completely or partially to spermatic cord block (greater than 50% decrease in pain) and had no identifiable reversible etiology. Postoperative pain rating scales (0 to 10) were used to determine efficacy.
Mean followup was 20.3 months (range 1 to 102 months) and complete, durable relief was noted in 67 (71%) testicular units, partial relief in 17 (17%), and unchanged in 11 (12%). No patients reported worse pain. Complications included testicular atrophy without hypogonadism in 2 patients, superficial wound infection in 2, hydrocele in 2 and an incisional hematoma in 1.
Microsurgical denervation of the spermatic cord is a minimally invasive, effective and durable management option for treatment of chronic orchialgia refractory to medical management, preserving the physiological function and psychological role of the testes.
我们评估了精索显微去神经术治疗慢性睾丸疼痛的长期疗效、并发症及患者感受。
对79名男性（平均年龄40.3岁，平均疼痛持续时间62个月，16例双侧）的95个睾丸单位进行精索显微去神经术以治疗慢性睾丸疼痛。所有患者保守治疗均失败，通过详细病史及体格检查对患者进行评估。每位男性若要成为精索显微去神经术的候选者，需对精索阻滞完全或部分有反应（疼痛减轻超过50%）且无明确的可逆病因。采用术后疼痛评分量表（0至10分）来确定疗效。
平均随访20.3个月（范围1至102个月），67个（71%）睾丸单位疼痛完全、持久缓解，17个（17%）部分缓解，11个（12%）无变化。无患者报告疼痛加重。并发症包括2例患者出现无性腺功能减退的睾丸萎缩，2例浅表伤口感染，2例鞘膜积液，1例切口血肿。
精索显微去神经术是治疗药物治疗无效的慢性睾丸疼痛的一种微创、有效且持久的治疗选择，可保留睾丸的生理功能和心理作用。
