Department of Urology, The East Division of the First Affiliated Hospital, Sun Yat-sen University.
Department of Urology, The East Division of the First Affiliated Hospital, Sun Yat-sen University;
J Vis Exp. 2022 May 25(183). doi: 10.3791/63780.
Chronic orchialgia is a common disease in department of urology and andrology. The etiology is complex, and the treatment is difficult. In severe cases, orchiectomy is even necessary. In recent years, microsurgical denervation of the spermatic cord (MDSC) is a minimally invasive and effective surgical method for the treatment of chronic orchialgia. Its greatest advantage is to preserve the testis and epididymis, avoid the possible organ resection. The key of the operation is to dissect all the fibrous tissues in the spermatic cord, while protecting the arteries (especially the testicular arteries) and several lymphatic vessels. Combined with the use of microvascular doppler in the operation, when separating the structure of spermatic cord under the microscope, the testicular arteries can be objectively and accurately protected (pulse "whistle" sound can be heard when the microvascular doppler probes the arterial surface), while artery injury and venous missed ligation can be avoided. The postoperative blood supply of the testis is also maximumly safeguarded. At the same time, we can be more fearless to cut the cremaster muscle, fatty and connective tissues surrounding the spermatic cord blood vessels and vas deferens after the arteries and lymphatic vessels being accurately protected under the microscope, finally achieve the spermatic cord completely "skeletonized" (only the testicular arteries, lymphatic vessels and vas deferens remained after the surgery). Thus we can better ensure the clinical curative effect (denervation thoroughly), avoid serious complications (testicular atrophy), and achieve better surgical results.
慢性睾丸痛是泌尿外科和男科的常见疾病。病因复杂，治疗困难，严重者甚至需要进行睾丸切除术。近年来，精索显微神经切除术（MDSC）是治疗慢性睾丸痛的一种微创、有效的手术方法。其最大的优势在于保留睾丸和附睾，避免了可能的器官切除。手术的关键是解剖精索中的所有纤维组织，同时保护动脉（尤其是睾丸动脉）和几条淋巴管。术中结合使用微血管多普勒，在显微镜下分离精索结构时，可以客观、准确地保护睾丸动脉（当微血管多普勒探头探测动脉表面时，可以听到脉搏“哨声”），同时避免动脉损伤和静脉结扎遗漏。最大程度地保障了睾丸的术后血供。同时，在显微镜下准确保护动脉和淋巴管后，我们可以更加无畏地切除提睾肌、精索血管和输精管周围的脂肪和结缔组织，最终使精索完全“骨骼化”（手术后仅保留睾丸动脉、淋巴管和输精管）。这样可以更好地保证临床疗效（彻底去神经），避免严重并发症（睾丸萎缩），并获得更好的手术效果。
