Laparoscopic treatment experiences of pediatric abdominoscrotal hydrocele

doi:10.3877/cma.j.issn.1674-3253.2020.03.016

Abstract

Abstract:

Objective

Summarize the clinical experiences of laparoscopic treatment of abdominoscrotal hydrocele.

Method

Retrospective analysis of the clinical manifestations, ultrasound findings, intraoperative findings and postoperative results of abdominoscrotal hydrocele.

Result

There were six children with abdominoscrotal hydrocele in that 5 patients were diagnosised with spermatic hydrocele preoperatively. Physical examination found high tension cystic mass from groin to the scrotum and positive light transmission. Ultrasound showed that the mass had amounts of fluid accumulation upper the testicle and extending to the abdominal cavity, sometimes visible separation were obeserved. In 2 cases, the abdominal mass was pushed into the sheath tube, then the sheath was ligated at a high position. Finally, the effusion was taken out through the scrotum. In other 4 cases, puncture needle was used to pierce the cystic mass in the abdominal cavity for draining the fluid,then capsule were pushed into the sheath tube, finially the sheath was ligated at a high position. Six patients were followed up for 10 months to 24 months without recurrence.

Conclusion

Laparoscopic treatment of abdominoscrotal hydrocele is effective.

Key words: Pediatric hydrocele, Abdominoscrotal hydrocele, Laparoscopy

Baiping Sun, Quan Xu, Ruogu Luo, Ansheng Bai, Xiongzhou Zhang, Yaru Shang. Laparoscopic treatment experiences of pediatric abdominoscrotal hydrocele[J]. Chinese Journal of Endourology(Electronic Edition), 2020, 14(03): 225-227.

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References 8

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病例	发病年龄（月）	手术年龄（月）	临床诊断	超声所见	术中所见及治疗方法
1	32	36	右侧精索鞘膜积液	右侧精索鞘膜腔积液73 mm×25 mm，右侧睾丸鞘膜积液12 mm×8 mm，左侧睾丸鞘膜积液5 mm×4 mm	腹腔镜探查左侧鞘状突闭合。右侧鞘状突未闭，直径5 mm，内环口处可见一直径2 cm囊性包块，自内环口处脱出。将包块推挤入鞘突管后，高位结扎鞘状突。经阴囊抽出淡黄色清亮积液约10 ml。
2	21	24	右侧精索鞘膜积液	右侧精索鞘膜积液41 mm×13 mm，左侧睾丸鞘膜积液8 mm×3 mm	腹腔镜探查左侧鞘状突已闭合。右侧鞘状突未闭，直径约5 mm，内环口精索外侧一囊性包块自内环口脱出，挤压阴囊包块增大。穿刺针刺破包块，黄色清凉液体流出，排尽囊液后，沿腹膜外潜行包绕鞘状突，将囊膜推挤入鞘突管后行右侧鞘状突高位结扎。
3	1	40	左侧精索鞘膜积液	左侧腹股沟区液体疝31 mm×27 mm，内环口直径8 mm，平卧包块缩小。腹腔内可探及32 mm×18 mm无回声区。	左侧鞘状突未闭，直径约15 mm，精索外侧囊性包块自内环口脱出。牵拉左侧阴囊，将囊性包块回纳至鞘突管后，高位结扎鞘状突。经阴囊抽出淡黄色清凉液体13 ml。
4	24	25	右侧精索鞘膜积液	右侧交通性鞘膜积液。腹股沟区睾丸后上方液性暗区90 mm×24 mm，内可见光带分割，向上与腹腔相同	右侧鞘状突未闭直径6 mm，内环口处囊性包块，4 cm×4 cm大小，自内环口脱出，牵拉或挤压阴囊，包块大小变化，刺破囊膜囊液黄色清亮，排空液体后，囊膜向鞘突管自行回缩。左侧鞘状突未闭3 mm，行双侧鞘状突高位结扎术。经阴囊抽出黄色清亮液体约20 ml。
5	5	17	右侧精索鞘膜积液	右侧阴囊至腹股沟区液性暗区，分别47 mm×22 mm，44 mm×16 mm，两液性暗区相通。	右侧鞘状突未闭，直径5 mm。经内环口脱出囊性包块，穿刺针戳破囊壁抽出淡黄色清凉液体，排尽液体，将囊壁经内环口还纳入鞘突管，行右侧鞘状突高位结扎术。经阴囊抽出淡黄色液体15 ml。
6	1	20	左侧腹股沟斜疝	左侧腹股沟区至阴囊内混合回声团块78 mm×63 mm×49 mm。内可见液性暗区，延伸至腹腔，与腹腔交通口6 mm	左侧鞘状突未闭，直径15 mm。内环口精索外侧腹膜后囊性包块，烧瓶状，透亮，刺破囊膜黄色清凉液体流出，排尽液体后行左侧鞘状突高位结扎术。

病例	发病年龄（月）	手术年龄（月）	临床诊断	超声所见	术中所见及治疗方法
1	32	36	右侧精索鞘膜积液	右侧精索鞘膜腔积液73 mm×25 mm，右侧睾丸鞘膜积液12 mm×8 mm，左侧睾丸鞘膜积液5 mm×4 mm	腹腔镜探查左侧鞘状突闭合。右侧鞘状突未闭，直径5 mm，内环口处可见一直径2 cm囊性包块，自内环口处脱出。将包块推挤入鞘突管后，高位结扎鞘状突。经阴囊抽出淡黄色清亮积液约10 ml。
2	21	24	右侧精索鞘膜积液	右侧精索鞘膜积液41 mm×13 mm，左侧睾丸鞘膜积液8 mm×3 mm	腹腔镜探查左侧鞘状突已闭合。右侧鞘状突未闭，直径约5 mm，内环口精索外侧一囊性包块自内环口脱出，挤压阴囊包块增大。穿刺针刺破包块，黄色清凉液体流出，排尽囊液后，沿腹膜外潜行包绕鞘状突，将囊膜推挤入鞘突管后行右侧鞘状突高位结扎。
3	1	40	左侧精索鞘膜积液	左侧腹股沟区液体疝31 mm×27 mm，内环口直径8 mm，平卧包块缩小。腹腔内可探及32 mm×18 mm无回声区。	左侧鞘状突未闭，直径约15 mm，精索外侧囊性包块自内环口脱出。牵拉左侧阴囊，将囊性包块回纳至鞘突管后，高位结扎鞘状突。经阴囊抽出淡黄色清凉液体13 ml。
4	24	25	右侧精索鞘膜积液	右侧交通性鞘膜积液。腹股沟区睾丸后上方液性暗区90 mm×24 mm，内可见光带分割，向上与腹腔相同	右侧鞘状突未闭直径6 mm，内环口处囊性包块，4 cm×4 cm大小，自内环口脱出，牵拉或挤压阴囊，包块大小变化，刺破囊膜囊液黄色清亮，排空液体后，囊膜向鞘突管自行回缩。左侧鞘状突未闭3 mm，行双侧鞘状突高位结扎术。经阴囊抽出黄色清亮液体约20 ml。
5	5	17	右侧精索鞘膜积液	右侧阴囊至腹股沟区液性暗区，分别47 mm×22 mm，44 mm×16 mm，两液性暗区相通。	右侧鞘状突未闭，直径5 mm。经内环口脱出囊性包块，穿刺针戳破囊壁抽出淡黄色清凉液体，排尽液体，将囊壁经内环口还纳入鞘突管，行右侧鞘状突高位结扎术。经阴囊抽出淡黄色液体15 ml。
6	1	20	左侧腹股沟斜疝	左侧腹股沟区至阴囊内混合回声团块78 mm×63 mm×49 mm。内可见液性暗区，延伸至腹腔，与腹腔交通口6 mm	左侧鞘状突未闭，直径15 mm。内环口精索外侧腹膜后囊性包块，烧瓶状，透亮，刺破囊膜黄色清凉液体流出，排尽液体后行左侧鞘状突高位结扎术。

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