机器人显微精索去神经术

慢性睾丸痛是指间歇性或持续性的单侧或双侧睾丸疼痛超过三个月,严重影响其生活质量促使患者寻求医学关注。病因包括输精管结扎术后疼痛综合征,精索静脉曲张,附睾囊肿等,其中有25%的患者找不到明确的病因,称为特发性睾丸痛。

手术适应证

  1. 慢性睾丸痛超过3个月。
  2. 其他标准的疼痛治疗方法无效。
  3. 无泌尿系统及神经系统病变。
  4. 精索封闭术有效。

术前准备

  1. 排除其他已知的影响睾丸疼痛的因素。
  2. 施行诊断性的精索封闭术。

麻醉与体位】腰麻和硬脊膜外联合麻醉,仰卧位。

手术方法和步骤

  1. 取经腹股沟切口,靠近下内侧约3cm长,依次切开皮肤、皮下组织、暴露精索并将其拖至切口外面。
  2. 达芬奇机器人及操作显微镜固定在术野上方。
  3. 辨别并分离输精管、睾丸动脉以及供应输精管的动脉,细小静脉和淋巴管。
  4. 游离并切除约1.5cm长输精管外膜组织,从而阻断了与之并行的交感神经。切断提睾肌纤维,从而切断了走行在其中的生殖股神经生殖支。
  5. 彻底止血后,依次关闭缝合。

术后处理

术后当天留置尿管,次日拔除。无须使用抗生素。

(张亚东 涂响安 邓春华)

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