Zhang Yuezhen,Sun Lingyun,Wu Xiongwei,et al.Application of methylene blue in the treatment of varicocele in children with single-port laparoscopic lymphatic vessel preservation[J].Journal of Clinical Pediatric Surgery,,20():365-369.[doi:10.12260/lcxewkzz.2021.04.012]
Application of methylene blue in the treatment of varicocele in children with single-port laparoscopic lymphatic vessel preservation
- Keywords:
- Laparoscopy; Lymphatic Vessels; Varicocele; Adolescent
- CLC:
- R726.9;R697+.24
- Abstract:
- Objective To explore the feasibility of varicocele treatment by umbilical single-hole laparoscopic lymphangiography after injecting methylene blue into testicular sheath cavity.Methods From July 2016 to October 2019, retrospective analysis was performed for 15 children with left varicocele.The average age was (12.67±1.03) (11-14) years.There were scrotal swelling (n=3) and scrotal mass (n=12).And the grades were Ⅱ (n=4) and Ⅲ (n=11).Preoperative ultrasonic diagnosis was made.On ultrasound, ipsilateral seminiferous vein thickened to varying degrees with an average inner diameter of (3.37±0.67) (2.40-4.80) mm.Single-port laparoscopic spermatic cord ligation was performed with lymphatic preservation.And 3 ml of methylene blue was injected intraoperatively into testicular sheath cavity.After a full development of lymphatic vessels, percutaneous puncture was performed with a hernia needle to avoid inner lymphatic vessels of spermatic cord while ligating seminiferous vessels.Testicular arteries were not preserved.Postoperative outcomes and recovery were observed.Results All operations were successful surgery.During a follow-up period of 6 to 18 months, clinical symptoms of scrotal mass and scrotal discomfort improved.There was no recurrence of varicocele, hydrocele, scrotal edema or scrotal pigmentation.All lymphatics were successfully visualized with at least one lymphatic vessel remaining.The average time from injection to development was (60.40±20.03) (30-90) seconds and, the average operative duration (40.13±11.25) (33-60) min, the average length of hospital stay (3.40±1.40) (1-6) days and the average disappearance time of blue staining of scrotum (4.40±1.45) (3-7) days.As compared with that pre-operation, bilateral testicular volume increased significantly postoperatively.Left testicular volume changed by (1.68±0.52) mm3 on average and right testicular volume by (1.58±0.44) mm3 on average.Conclusion Through single-hole laparoscopic intrathecal testicular sheath injection of methylene blue to preserve lymphatic vessels for treatment of varicocele in children, the spermatic cord lymphatic vessels may be distinctly visualized, lymphatic vessels retained and postoperative hydrocele and scrotal edema prevented.And the method is easy to operate with a hernia needle with shorter operative duration, minimal surgical incision and more pleasant cosmetics.
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Memo
收稿日期:2020-01-14。
基金项目:青岛市民生科技计划项目（编号：18-6-1-71-nsh）
通讯作者:鹿洪亭,Email:luhongting@126.com