epididymectomy

Epididymal diseases are mainly infectious diseases, which can be divided into non-specific infections and specific infections. Non-specific infections include acute epididymitis and chronic epididymitis; the most common type of infection is epididymal tuberculosis, and gonorrhea epididymitis. Epididymal tumors are rare. In addition, there are epididymal cysts, epididymal stagnation after vasectomy. Surgical treatment of the above diseases include epididymal resection, epididymal cystectomy, and epididymal decompression drainage of acute epididymitis. The main target of epididymal resection is epididymal tuberculosis, followed by chronic epididymitis and epididymal tumors. Treating diseases: chronic epididymitis Indication Epididymal disease and epididymal resection apply to: 1. Epididymal tuberculosis is not effective in anti-tuberculosis treatment, especially if it has formed a cold abscess, adhesion to the skin, or has formed a sinus. 2. Chronic epididymitis, long-term unhealed by non-surgical treatment, and the symptoms are still obvious, and there is no fertility requirement. 3. Benign tumor of the epididymis. Contraindications Unmarried and uncultivated persons are relative contraindications. Preoperative preparation 1. Epididymal tuberculosis patients apply anti-tuberculosis drugs for at least 2 weeks before surgery. 2. If there is a mixed infection, preoperative antibacterial drug control. 3. Shave the pubic hair 1d before surgery. Surgical procedure 1. Incision: anterior lateral longitudinal incision of the scrotum. The scrotal wall was cut layer by layer until the testicular sheath wall layer. The detachment of the sheath sac separates the sheath sac from the scrotum contents out of the incision. 2. Exploring the epididymis: Incision of the testicular sheath, revealing the testis, epididymis and distal spermatic cord. Check the size, extent and adhesion of the epididymal lesions, paying particular attention to the adhesion to the spermatic vessels. After deciding to remove the epididymis, the vas deferens is freed from the spermatic cord. 3. Free epididymis: first release the epididymis body, use the tissue forceps to lift the epididymis body, use the small round knife or scissors to free the epididymis from the testicles, taking care not to damage the adjacent spermatic vessels. Continue to free up and down the epididymis head and tail. It can be freed from the surface of the testicular white membrane. If the adhesion is tight, it can be released on the surface of the visceral sheath of the epididymis to avoid damage to the spermatic vessels. 4. Excision of the epididymis: After the entire epididymis is released from the testis, the vas deferens is cut at a high position, and the epididymis is cut off (Fig. 7.9.5-5). The testicular wounds were sutured with thin wires. 5. Treatment of vas deferens stump: The cut vas deferens stump is brushed with sulphuric acid, ethanol and saline, and then ligated with silk. In the case of epididymal tuberculosis, the stump of the vas deferens should be pulled out through the other skin of the scrotum root and fixed on the skin to avoid infection of the incision caused by the stump. 6. Suture the incision: remove the excess testicular sheath and flip the suture. The outer fascia of the spermatic cord is sutured to cover the spermatic vessels. Place the testicles back into the scrotum, make another puncture at the lower edge of the incision or from the bottom of the scrotum, and place the rubber sheet for drainage. The scrotal skin incision was sutured with a thin thread for vertical suture. complication 1. Bleeding: It is caused by rough operation and incomplete hemostasis during operation. Small hemorrhage in the scrotum is treated by patency or drainage of blood, scrotum cold compress and pressurization. If the wound drain has blood flow or the scrotum progressively increases, the suture should be removed, the hematoma should be removed, the bleeding should be completely stopped and the drainage strip placed. 2. Infection: Most cases are caused by chronic infection of the scrotal skin, unclean skin, less disinfection, more intraoperative tissue damage, no drainage or poor drainage, and improper postoperative care. After the infection occurs, anti-infective treatment, local hot compress or other physical therapy should be strengthened, and the circulation should be kept smooth. If an abscess is formed, the drainage should be cut open. 3. Sinus sinus formation: mainly due to tuberculous lesions contaminated wounds, vas deferens stumps are not external, and preoperative and postoperative anti-tuberculosis treatment and other factors. If there is scrotal sinus formation, systemic treatment and anti-tuberculosis treatment should be strengthened, and scrotal sinus resection should be performed 1 month later. 4. Testicular necrosis: mainly due to epididymal lesions caused by close adhesion of the spermatic cord and epididymis, mistakenly ligating the internal spermatic artery, or ligation of the internal spermatic artery due to massive tissue clamp hemostasis. If the testicular has atrophy after surgery, if there is no complication, it can not be treated; if there is infection, it is feasible to remove the testicular. 5. The development of the epididymal tuberculosis in the healthy side: mainly due to the obvious epithelial tuberculosis patients with obvious prostate and seminal vesicle tuberculosis, the joint vas deferens were not ligated during the operation. Causes tuberculosis to spread retrogradely to the healthy epididymis. In the case of healthy epididymal tuberculosis, in addition to strengthening systemic therapy and anti-tuberculosis treatment, the epididymis should also be considered for resection.