Department of Urology, The First People's Hospital of Yunnan Province (Medical College of Kunming University of Science and Technology);
Department of Urology, The First People's Hospital of Yunnan Province (Medical College of Kunming University of Science and Technology).
J Vis Exp. 2023 Mar 31(193). doi: 10.3791/64083.
Epididymal cysts mostly occur in men aged 20-40 years old. Previous reports have covered concerns about postoperative complexes, including postoperative asoedema, hematoma, sustaining pain, and seminal tract obstruction in patients who have undertaken nonmicroscopic epididymal cyst resection or epididymal resection. Nonmicroscopic epididymal cyst surgery is suggested for patients with childbirth plans as a precaution. The treatment of male epididymal cysts via microtechnology is obviously a beneficial option; we took the lead in carrying out microscopic epididymal exploration and cyst resection surgery in China. From September 2017 to April 2021, 41 young and middle-aged male patients diagnosed with epididymal cysts underwent microtechnology treatment in a program titled "microscopic epididymal exploration and cystectomy". The postoperative follow-up lasted for 3-50 months. The results confirmed that, as microscopic manipulation largely improved visualization of the subtle tissue structures of the epididymis, the cyst could be clearly dissected apart and completely removed intact under the microscope. Bleeding during the operation was significantly reduced (2-3 mL) and wound drainage was not required. According to follow-up data, microscopic treatment significantly reduced the incidence of postoperative scrotal hematoma, edema, and long-term postoperative pain, thereby promising a higher surgical success rate as well as recurrence prevention. Besides, preliminary experience and reflection suggest that microscopic epididymal exploration and cystectomy provide efficient preservation of the epididymal patency through refined treatment, while a better prognosis can be achieved. We recommend that surgery be carried out before the epididymal cyst develops to 0.8 cm in diameter, for fear that a larger epididymal cyst (>0.9 cm in diameter) could cause the complete destruction of all tubules of the ipsilateral epididymis - a more severe case with damage to the testicular output network.
附睾囊肿主要发生在 20-40 岁的男性。既往报道对接受非显微镜下附睾囊肿切除或附睾切除术的患者，关注术后并发症，包括术后阴囊水肿、血肿、持续性疼痛和精液输送通道阻塞。有生育计划的患者建议进行非显微镜下附睾囊肿手术，作为预防措施。通过微技术治疗男性附睾囊肿显然是一个有益的选择；我们率先在中国开展了显微镜下附睾探查和囊肿切除术。2017 年 9 月至 2021 年 4 月，41 例中青年男性附睾囊肿患者在“显微镜下附睾探查和囊肿切除术”项目中接受微技术治疗。术后随访 3-50 个月。结果证实，由于显微镜下操作大大改善了对附睾细微组织结构的可视化，囊肿可以在显微镜下清晰分离并完整切除。术中出血量明显减少（2-3 毫升），无需伤口引流。根据随访资料，显微镜治疗明显降低了术后阴囊血肿、水肿和长期术后疼痛的发生率，从而提高了手术成功率和预防复发的效果。此外，初步的经验和反思表明，显微镜下附睾探查和囊肿切除术通过精细化治疗，有效地保持了附睾的通畅性，从而实现了更好的预后。我们建议在附睾囊肿直径达到 0.8cm 之前进行手术，因为担心较大的附睾囊肿（直径>0.9cm）可能导致同侧附睾的所有小管完全破坏，这种情况更严重，会损伤睾丸输出网络。
