Patoulias Ioannis, Rachmani Evangelia, Kalogirou Maria, Chatzopoulos Kyriakos, Patoulias Dimitrios
1st Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G. Gennimatas", Thessaloniki, Greece.
4th Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokration General Hospital, Greece.
Acta Medica (Hradec Kralove). 2018;61(2):41-46. doi: 10.14712/18059694.2018.49.
The aim of this study is to describe an entity of primary hydrocele accompanied with fibrosis, thickening and hemorrhagic infiltration of parietal layer of tunica vaginalis (PLTV). During a 4-year period (2011-2014), 94 boys (2.5-14 years old) underwent primary hydrocele repair. Hydrocele was right sided in 55 (58.5 %), left sided in 26 (28.7%) and bilateral in 12 patients (13.8%). Eighty three out of 94 patients (88.30%) had communicating hydrocele and the rest eleven patients (11.7%) had non-communicating. Our case group consists of 8 patients (8.51%) based on operative findings consistent with PLTV induration, thickening and hemorrhagic infiltration. Preoperative ultrasonography did not reveal any pathology of the intrascrotal structures besides hydrocele. There weren't hyperechoic reflections or septa within the fluid. Evaluation of thickness of the PLTV was not feasible. Presence of lymph or exudate was excluded after fluid biochemical analysis. Tunica vaginalis histological examination confirmed thickening, hemorrhagic infiltration and inflammation, while there was absence of mesothelial cells. Immunochemistry for desmin was positive, excluding malignant mesothelioma. One patient underwent high ligation of the patent processus vaginalis and PLTV sheath fenestration, but one year later, he faced a recurrence. An elective second surgery was conducted via scrotal incision and Jaboulay operation was performed. The latter methodology was our treatment choice in other 7 out of 8 patients. During a 2-year postoperative follow-up, no other patient had any recurrence. We conclude that in primary hydrocele with macroscopic features indicative of tunica vaginalis inflammation, reversion of the tunica should be a part of operative strategy instead of sheath fenestration, in order to minimize the recurrence.
本研究的目的是描述一种伴有鞘膜壁层（PLTV）纤维化、增厚和出血性浸润的原发性鞘膜积液实体。在4年期间（2011 - 2014年），94名男孩（2.5 - 14岁）接受了原发性鞘膜积液修复手术。鞘膜积液右侧55例（58.5%），左侧26例（28.7%），双侧12例（13.8%）。94例患者中83例（88.30%）为交通性鞘膜积液，其余11例（11.7%）为非交通性鞘膜积液。根据手术结果，我们的病例组包括8例患者（8.51%），其表现符合PLTV硬结、增厚和出血性浸润。术前超声检查除鞘膜积液外未发现阴囊内结构有任何病变。积液内无高回声反射或分隔。评估PLTV的厚度不可行。液体生化分析排除了淋巴液或渗出液的存在。鞘膜组织学检查证实有增厚、出血性浸润和炎症，同时未见间皮细胞。结蛋白免疫化学呈阳性，排除恶性间皮瘤。1例患者接受了未闭鞘状突高位结扎和PLTV鞘开窗术，但1年后复发。通过阴囊切口进行了择期二次手术，并实施了贾布莱手术。后一种方法是我们对8例患者中另外7例的治疗选择。术后2年随访期间，无其他患者复发。我们得出结论，对于具有鞘膜炎症宏观特征的原发性鞘膜积液，为了尽量减少复发，手术策略应包括鞘膜翻转而非鞘开窗。
