超声引导精索阻滞下F4.8可视肾镜治疗附睾良性肿物的疗效分析

目的 评估在超声引导精索阻滞下，应用F4.8可视肾镜治疗附睾良性肿物的疗效及安全性。方法 选取 82例附睾肿物患者，采用随机数字表法分为盲探穿刺组和超声引导穿刺组，每组41例。所有患者均应用F4.8可视肾 镜作为阴囊镜施行手术。盲探穿刺组于腹股沟管外环处盲探穿刺进行精索阻滞；超声引导穿刺组利用彩色多普勒 超声诊断仪完成精索阻滞。记录患者的手术时间、围手术期并发症、精索阻滞成功率、血管性并发症、术中麻醉性药 物追加以及麻醉方式更改情况。采用视觉模拟评分（VAS）对患者进行疼痛评估，并对患者进行随访。结果 64例 附睾囊肿患者均予镜下钬激光囊肿去顶术；18例附睾实性肿物患者镜下确诊为附睾附件不全扭转，予钬激光切除。 与盲探穿刺组相比，超声引导穿刺组的精索阻滞成功率更高，血管性并发症发生率、麻醉方式更改率更低（P＜0.05）， 2组术中麻醉性药物追加率差异无统计学意义。超声引导穿刺组在手术5 min、术后2 h的VAS和住院费用低于盲探 穿刺组（P＜0.05），术后6 h、12 h VAS，住院时间2组差异无统计学意义。随访患者术后1个月、3个月及12个月复查 阴囊彩超，未见患侧睾丸、附睾及精索异常。结论 超声引导精索阻滞下F4.8可视肾镜治疗附睾肿物安全有效，可 作为理想的检查、治疗方法，具有较好的应用价值。

Efficacy analysis of F4.8 visual nephroscope under ultrasound-guided spermatic cord block in the treatment of benign epididymal tumors

Objective To evaluate the safety and efficacy of 4.8Fr micro-percutaneous nephrolithotomy in the diagnosis and treatment of epididymal benign mass under ultrasound-guided spermatic cord block. Methods Eighty-two patients diagnosed with epididymal mass underwent scrotal surgery with the application of 4.8Fr micro-percutaneous nephrolithotomy from January 2018 to May 2021 in our hospital. They were randomly divided into conventional blind puncture group (group R, 41 cases) and ultrasound-guided puncture group (group U, 41 cases). The surgical efficacy, scrotum pain score, complications and recurrence of lesions were recorded. Results All the 82 patients were successfully performed scrotal cystoscopy without severe complications occurred, such as scrotal hematoma, testicular rupture or epididymis injury. Sixty-four cases diagnosed with epididymal cyst accepted laser resection of the cyst. Eighteen cases of epididymal solid mass were diagnosed as incompletely torsion of the testicular or epididymosis accessory, and underwent holmium laser ablation. The U group had higher successful rate of spermatic cord block, lower rate of vascular complications and conversion of anesthesia mode, compared with R group, which had significantly statistical differences (P<0.05). However, there was no significant difference in intraoperative anesthetic drug addition between two groups (P>0.05). There were significantly statistical differences according to the pain score of 5 min and 2h, and hospitalization cost between two group (P<0.01), while the differences of pain score of 6h and 12h, and time of hospitalization were not significant (P> 0.05). The scrotal ultrasonography was performed after 1 and 3 month, and no abnormal structure was observed. Conclusion The technique of 4.8Fr micro-percutaneous nephrolithotomy under ultrasound-guided spermatic cord block could be an ideal inspection and treatment method for epididymal benign mass, and it is worth promoting.