经腹腹膜前疝修补术或髂耻束修补术腹腔镜治疗囊性精索鞘膜积液。
Laparoscopic hydrocelectomy with transabdominal preperitoneal hernioplasty or iliopubic tract repair for treatment of encysted spermatic cord hydrocele.
机构信息
Department of Surgery, Damsoyu Hospital, 234 Hakdong-ro, Gangnam-gu, Seoul, Republic of Korea.
出版信息
Surg Endosc. 2022 Jul;36(7):5540-5545. doi: 10.1007/s00464-022-09285-9. Epub 2022 May 5.
BACKGROUND
An encysted spermatic cord hydrocele (ESCH) causes an inguinal swelling resembling an inguinal hernia (IH). An ESCH should be considered as a differential diagnosis of IH. Although laparoscopic operations have been performed to treat ESCHs in pediatric patients, such operations have not been reported in adults. This study was performed to evaluate the outcomes of laparoscopic hydrocelectomy for treatment of ESCHs in adults.
METHODS
The medical charts of 49 patients who underwent laparoscopic transabdominal hydrocelectomy for ESCHs from January 2015 to December 2020 at a single institution were retrospectively reviewed. The patients were divided into those with and without an IH. Laparoscopic hydrocelectomy was performed, and the internal inguinal ring was closed with iliopubic tract repair (IPTR) or transabdominal preperitoneal (TAPP) hernioplasty depending on the presence of an IH. The patients' age, ESCH location, postoperative complications, recurrence, and operating time were examined.
RESULTS
The patients' mean age was 46.7 (20-77) years. All patients underwent laparoscopic hydrocelectomy without open conversion. ESCHs were more common on the right side (35/49, 71.4%) than on the left (14/49, 28.6%). The presenting symptom in all patients was inguinal swelling. The ESCH was located inside the inguinal canal in 47 patients and protruded to the abdominal cavity from the inguinal canal in 2 patients. After laparoscopic hydrocelectomy, 32 patients without an IH underwent IPTR and 17 patients with an IH underwent TAPP hernioplasty. The mean operating time was shorter in the IPTR than TAPP hernioplasty group. The postoperative complications and hospital stay were not different between the two groups. There were no recurrences in either group.
CONCLUSIONS
Laparoscopic hydrocelectomy with IPTR or TAPP hernioplasty is safe and feasible for treatment of ESCHs in adults.
背景
囊状精索鞘膜积液（ESCH）可导致腹股沟肿胀，类似于腹股沟疝（IH）。ESCH 应被视为 IH 的鉴别诊断。虽然腹腔镜手术已用于治疗小儿患者的 ESCH，但在成人中尚未报道此类手术。本研究旨在评估腹腔镜精索鞘膜切除术治疗成人 ESCH 的疗效。
方法
回顾性分析 2015 年 1 月至 2020 年 12 月在一家单中心接受腹腔镜经腹精索鞘膜切除术治疗 ESCH 的 49 例患者的病历。患者分为伴有 IH 和不伴有 IH 两组。行腹腔镜精索鞘膜切除术，如果存在 IH，则采用髂耻束修补术（IPTR）或经腹腹膜前修补术（TAPP）疝修补术封闭内环。检查患者的年龄、ESCH 位置、术后并发症、复发和手术时间。
结果
患者的平均年龄为 46.7（20-77）岁。所有患者均行腹腔镜精索鞘膜切除术，无中转开放手术。49 例患者中，右侧 ESCH 较左侧（35/49，71.4%比 14/49，28.6%）更为常见。所有患者的首发症状均为腹股沟肿胀。47 例 ESCH 位于腹股沟管内，2 例从腹股沟管突出至腹腔。腹腔镜精索鞘膜切除术后，32 例无 IH 患者行 IPTR，17 例 IH 患者行 TAPP 疝修补术。IPTR 组的平均手术时间短于 TAPP 疝修补术组。两组术后并发症和住院时间无差异。两组均无复发。
结论
IPTR 或 TAPP 疝修补术治疗成人 ESCH 安全可行。
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