Marchal Escalona C, Chicharro Molero J A, Martín Morales A, Del Rosal Samaniego J M, Díaz Ramírez F, Ruiz Domínguez J L, Burgos Rodríguez R
Servicio de Urología, Hospital R. Carlos Haya, Málaga.
Actas Urol Esp. 1993 Jan;17(1):68-72.
Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.
传统上，对于阴道积液的处理一直是采用手术治疗。该疾病的良性性质与所使用麻醉技术导致的发病率并不相符。在过去几年中，硬化疗法作为鞘膜积液切除术的替代方法越来越受到关注。然而，其适应症有限，复发率会因所使用的药物和手术团队的不同而有所差异。本研究提议在阴道积液手术中使用局部麻醉，以尽量缩短术后即刻恢复时间，从而减少住院时间。1991年5月至10月期间，我们科室共治疗了55例患者，其中49例为鞘膜积液（4例双侧），6例为精索囊肿。在手术过程中对患者进行监测（心电图、血压和血氧饱和度仪）以监控其生命体征，并将2%的甲哌卡因（10 - 20毫升）注入精索和即将切开的阴囊壁区域。手术技术包括从对囊袋进行解剖到剪开直至部分外翻，需要使用可吸收缝线并仔细止血以避免引流。52例患者（94%）对麻醉的耐受性非常满意，1例患者（2%）良好，2例患者（4%）不满意。记录的并发症包括：1例患者出现严重心动过缓和低血压（2%），1例患者持续存在右肾输尿管疼痛（2%），5例患者出现阴囊血肿（9%），另1例患者出现缝线裂开（2%）。结论是，采用局部麻醉进行阴道积液的手术治疗是可行的，可缩短术后即刻恢复时间，同时避免因采用更激进的麻醉技术而产生的发病率。
