靶向机器人辅助精索神经切断术治疗慢性精索痛或腹股沟痛：单中心大系列回顾。

Targeted Robotic Assisted Microsurgical Denervation of the Spermatic Cord for the Treatment of Chronic Orchialgia or Groin Pain: A Single Center, Large Series Review.

机构信息

PUR Clinic and South Lake Hospital, Clermont, Florida; Keiser University Graduate School (RM, BD), Fort Lauderdale, Florida.

出版信息

J Urol. 2018 Apr;199(4):1015-1022. doi: 10.1016/j.juro.2017.10.030. Epub 2017 Oct 25.

DOI:10.1016/j.juro.2017.10.030

PMID:29079446

Abstract

PURPOSE

Microsurgical denervation of the spermatic cord is a treatment option for chronic orchialgia refractory to conservative treatment. A recent study showed specific nerve fibers as the possible cause of chronic orchialgia. Our goal was to present the outcomes of ligation of these nerves using a technique of targeted robotic assisted microsurgical denervation of the spermatic cord.

MATERIALS AND METHODS

We retrospectively reviewed the records of 772 patients who underwent targeted robotic assisted microsurgical denervation of the spermatic cord from October 2007 to July 2016. Selection criteria were chronic testicular pain more than 3 months in duration, failed conservative treatments, negative neurological and urological workup, and temporary resolution of pain with a local anesthetic spermatic cord block. Targeted robotic assisted microsurgical denervation of the spermatic cord was performed. Pain was assessed preoperatively and postoperatively using a subjective visual analog scale and objectively with the standardized and validated PIQ-6 (Pain Impact Questionnaire-6) score.

RESULTS

Followup data were available on 860 cases. During a median followup of 24 months (range 1 to 70) 718 cases (83%) showed a significant reduction in pain and 142 (17%) had no change in pain by subjective visual analog scale scoring. Of cases with a significant reduction in pain 426 (49%) had complete resolution and 292 (34%) had a 50% or greater reduction. Objective PIQ-6 analysis showed a significant reduction in pain in 67% of patients 6 months postoperatively, in 68% at 1 year, in 77% at 2 years, in 86% at 3 years and in 83% at 4 years.

CONCLUSIONS

Targeted robotic assisted microsurgical denervation of the spermatic cord is an effective, minimally invasive approach with potential long-term durability in patients with refractory chronic orchialgia.

摘要

目的

精索显微神经切断术是治疗慢性睾丸痛的一种治疗选择，这种疼痛对保守治疗无效。最近的一项研究表明，特定的神经纤维可能是慢性睾丸痛的原因。我们的目标是展示使用靶向机器人辅助精索显微神经切断术治疗这些神经的结果。

材料和方法

我们回顾性分析了 2007 年 10 月至 2016 年 7 月期间 772 例接受靶向机器人辅助精索显微神经切断术的患者记录。选择标准为：睾丸疼痛持续 3 个月以上，保守治疗失败，神经和泌尿科检查均为阴性，局部麻醉精索阻滞可暂时缓解疼痛。行靶向机器人辅助精索显微神经切断术。术前和术后采用主观视觉模拟评分（VAS）和标准化、验证后的 PIQ-6（疼痛影响问卷-6）评分进行疼痛评估。

结果

772 例患者中有 860 例可获得随访数据。中位随访时间为 24 个月（范围 1 至 70 个月），718 例（83%）VAS 评分显示疼痛明显减轻，142 例（17%）疼痛无变化。在疼痛明显减轻的病例中，426 例（49%）完全缓解，292 例（34%）疼痛减轻 50%或以上。术后 6 个月、1 年、2 年、3 年和 4 年，客观的 PIQ-6 分析显示 67%、68%、77%、86%和 83%的患者疼痛减轻。