Hori Satoshi, Sengupta Anup, Shukla Chitranjan J, Ingall Elizabeth, McLoughlin John
Department of Urology, West Suffolk Hospital, Bury St. Edmunds, United Kingdom.
J Urol. 2009 Oct;182(4):1407-12. doi: 10.1016/j.juro.2009.06.020. Epub 2009 Aug 15.
We evaluated the long-term outcomes of patients who underwent epididymectomy for the treatment of chronic epididymal pain.
All 72 patients who underwent epididymectomy at our institution between 1994 and 2007 were invited to participate in the study. Patients were mailed questionnaires covering various aspects of the treatment. Questions regarding pain were rated on a scale between 0 and 10 (0--no pain, 10--severe pain). Patients who did not return the questionnaires were followed up by telephone and the medical case notes of all respondents were reviewed. Statistical analysis was performed using the Wilcoxon signed-rank and Fisher's exact tests with p <0.05 considered statistically significant.
A total of 53 patients participated (74% response rate) and mean followup was 7.4 years. Of these patients 45 (84.9%) underwent epididymectomy for post-vasectomy pain and the remainder (8 of 53, 15.1%) had the procedure for various nonvasectomy reasons. There were significant improvements in pain score in the post-vasectomy (mean 7.3 preoperative to 2.4 postoperative, p <0.001) and nonvasectomy (mean 7 preoperative to 2.8 postoperative, p = 0.002) groups. Of the patients in the post-vasectomy group 93.3% (42 of 45) had less or no pain postoperatively compared to 75% (6 of 8) in the nonvasectomy group. The satisfaction rate with epididymectomy was also higher in the post-vasectomy (42 of 45, 93.3%) compared to the nonvasectomy (5 of 8, 62.5%) group (p = 0.038).
With high patient satisfaction and a favorable long-term outcome epididymectomy appears to be an effective treatment option particularly for post-vasectomy chronic epididymal pain.
我们评估了接受附睾切除术治疗慢性附睾疼痛患者的长期疗效。
邀请了1994年至2007年间在我院接受附睾切除术的所有72例患者参与本研究。向患者邮寄涵盖治疗各个方面的问卷。关于疼痛的问题采用0至10分制评分（0分——无疼痛，10分——剧痛）。未回复问卷的患者通过电话进行随访，并查阅所有受访者的病历。采用Wilcoxon符号秩和检验与Fisher精确检验进行统计分析，p<0.05被认为具有统计学意义。
共有53例患者参与（应答率74%），平均随访时间为7.4年。其中45例（84.9%）因输精管结扎术后疼痛接受附睾切除术，其余53例中的8例（15.1%）因各种非输精管结扎原因接受该手术。输精管结扎术后组（术前平均7.3分，术后平均2.4分，p<0.001）和非输精管结扎术后组（术前平均7分，术后平均2.8分，p = 0.002）的疼痛评分均有显著改善。输精管结扎术后组93.3%（45例中的42例）术后疼痛减轻或无疼痛，而非输精管结扎术后组为75%（8例中的6例）。输精管结扎术后组附睾切除术的满意率（45例中的42例，93.3%）也高于非输精管结扎术后组（8例中的5例，62.5%）（p = 0.038）。
附睾切除术具有较高的患者满意度和良好的长期疗效，似乎是一种有效的治疗选择，尤其对于输精管结扎术后慢性附睾疼痛。
