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,2021,20(04):365-369.[doi:10.12260/lcxewkzz.2021.04.012]
亚甲蓝在单孔腹腔镜保留淋巴管治疗小儿精索静脉曲张中的应用
- Title:
- Application of methylene blue in the treatment of varicocele in children with single-port laparoscopic lymphatic vessel preservation
- Keywords:
- Laparoscopy; Lymphatic Vessels; Varicocele; Adolescent
- 分类号:
- R726.9;R697+.24
- 摘要:
- 目的 探讨向睾丸鞘膜腔注射亚甲蓝后，经脐单孔腹腔镜淋巴管显影治疗精索静脉曲张的可行性。方法 回顾性收集2016年7月至2019年10月由青岛大学附属医院收治的15例精索静脉曲张患者作为研究对象，患侧均为左侧；3例以阴囊坠涨感就诊，12例以阴囊肿物就诊；Ⅱ级4例，Ⅲ级11例。所有患者术前行B超检查确诊，B超结果提示患侧精索静脉有不同程度的增粗，内径直径为2.40~4.80 mm，平均（3.37±0.67）mm。患者年龄11~14岁，平均（12.67±1.03）岁，所有患者行单孔腹腔镜下保留淋巴管的精索静脉高位结扎术，术中向睾丸鞘膜腔注入亚甲蓝3 mL，待淋巴管充分显影后，用带线疝针经皮穿刺避开精索内淋巴管的同时行高位结扎精索血管术，所有患者未保留睾丸动脉，观察患者术后治疗效果以及恢复情况。结果 所有患者手术获得成功，术后随访6~18个月，阴囊肿物，阴囊不适感均获得改善，无精索静脉曲张的复发，无鞘膜积液、阴囊水肿、阴囊色素沉积发生。淋巴管均成功显影，至少保留1根淋巴管，从注射到显影时间为30~90 s，平均（60.40±20.03）s。手术时间33~60 min，平均（40.13±11.25）min。患者住院时间1~6 d，平均（3.40±1.40）d，阴囊蓝染消失时间3~7 d，平均（4.40±1.45）d。与术前相比术后双侧睾丸体积明显增大，左侧睾丸体积平均增大（1.68±0.52）mm3，右侧睾丸体积平均增大（1.58±0.44）mm3。结论 通过单孔腹腔镜下睾丸鞘膜腔内注射亚甲蓝保留淋巴管治疗小儿精索静脉曲张，可使精索内淋巴管清晰显影，便于保留淋巴管，避免术后鞘膜积液、阴囊水肿等并发症的发生，且该方法疝针操作方便，手术时间短，手术切口小，更加美观。
- 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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备注/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