Ma qingquan,Li Yanan,Wang Qi,et al.Clinical research progress in the pathogenesis of congenital hydrocele in children.[J].Journal of Clinical Pediatric Surgery,,17():433-437.
Clinical research progress in the pathogenesis of congenital hydrocele in children.
Journal of Clinical Pediatric Surgery[ISSN:1671-6353/CN:43-1380/R]
volume:
第17卷
Number:
2018 06
Page:
433-437
Column:
论著
Date of publication:
2018-06-28
- Keywords:
- Testicular Hydrocele; Laparoscopes; Pathogenesis; Child
- Document code:
- A
- Abstract:
- ObjectivePediatric processus vaginalis of uncommunicating hydrocele is perceived to stay in a closed state at inner ring and fluid in sac is derived from the secretion of sac wall itself. The present study was intended to explore the possible pathogenesis of congenital hydrocele (esp. uncommunicating hydrocele). MethodsBetween January 2002 and December 2015,395 boys aged >2 years with congenital hydrocele underwent laparoscopy for exploring the closure of sheath of inguinal inner ring. Within the same period,34 patients voluntarily opting for traditional open surgery were selected for histological study to investigate the structure of cyst wall. Then methylthionine chloride was injected into processus vaginalis of 25 laparoscopic patients to understand the possible source of fluid in congenital hydrocele. After miniinvasive laparoscopic highligations of processus vaginalis at internal inguinal ring,percutaneous puncture,aspiration of sac and postoperative followups were performed for evaluating the therapeutic efficacies. ResultsPathological research of 34 patients with open surgery revealed that sac of hydrocele was composed predominantly of a monolayer of flat epithelial cells and secretion function was rather weak. According to the changes in cyst size in 395 laparoscopic patients,the preoperative diagnosis was communicating hydrocele (n=134) and uncommunicating hydrocele (n=261). Under laparoscope,open processus vaginalis with communicating hydrocele was observed at internal inguinal ring. Processus vaginalis communicated with cavity of periorchium by a tube of 2-3 cm. Transparent liquids flew into peritoneal cavity through internal inguinal ring when pressing sac of hydrocele; For 261 patients with uncommunicating hydrocele,open processus vaginalis was observed at internal inguinal ring. Processus vaginalis communicated with sac of uncommunicating hydrocele by a tube. A small amount of liquid exudated through connecting hole in sac roof of hydrocele when pressing sac of hydrocele. After an injection of methylthionine chloride into open processus vaginalis,methylthionine chloride was aspirated by a puncture in communicating hydrocele or uncommunicating hydrocele 30 min later. The postoperative mean followup of 395 children was over 1 year after laparoscopic high ligation of sheath. Only 6 children had the postoperative unilateral recurrence rate of 1-3 months and a curative rate of 98.5%. ConclusionIn contrast to the traditional concept,the developmental failure of closure of processus vaginalis is a major pathogenic factor for congenital hydrocele. Sac of hydrocele is composed predominantly of a monolayer flat epithelial cells. And capsular fluid is not secreted by wall itself but derived from normal ascites of abdominal cavity. Oneway valve structure may exist in connecting hole in sac roof of hydrocele and it prevents a reflux of liquid into peritoneal cavity.
Last Update:
2018-06-26