背景:Nuck管的鞘膜积液是由于在胎儿发育过程中阴道突的不完全闭塞或圆形韧带的异常出袋而引起的疾病。它通常表现为无痛,很少痛苦,腹股沟肿胀。这种情况的明确诊断是磁共振成像。针对这种情况,已经提出了各种管理选项,包括开放手术,经腹腹膜前入路,完全腹膜外入路,以及腹腔镜和开腹手术的结合。本研究强调了与开放前入路相比,经腹腹膜前入路的优势,并解决了腹腔镜手术中面临的术中挑战。
方法:该研究是一项回顾性研究,包括2019年6月至2023年12月接受Nuck管鞘膜积液手术的20例患者。对患者的病例记录进行了研究,以获取人口统计特征等信息,病理类型,进行的手术,术中遇到的挑战,手术时间,住院时间,不同时间间隔的视觉模拟量表疼痛评估表的分数,以及重返工作岗位所需的时间。对变量进行记录和统计分析。
结果:研究人群的平均年龄为27.8±8.34岁。在这20名患者中,10人接受了经腹腹膜前入路(A组),10例接受了开放的前路手术(B组)。20名患者中有11名患有腹股沟疝,其中3个是术前鉴定的,8个是在手术中偶然鉴定的。A组平均手术时间为97.95±7.54分钟,B组为66.3±6.20分钟。Mann-WhitneyU检验显示,B组的手术时间明显少于A组(p值<0.001)。两组的住院时间相当,差异无统计学意义(2天对3.8±3.08天,分别)。当使用Mann-WhitneyU检验比较A组和B组之间恢复正常工作所需时间的平均值差异时(6.1±0.87天和11.2±1.81天,分别),在前一组中,发现有统计学意义的早期恢复正常工作(p值=0.001).同样,Mann-WhitneyU检验用于比较两组12-24小时的中位术后疼痛评分,48-72小时,七天,和3个月时,A组患者的疼痛评分均显著降低(p值<0.001,p值=0.005,p值=0.005,p值<0.001).术中挑战的发生率,血清血肿,与手术部位感染相比无统计学意义。
结论:经腹腹膜前入路治疗Nuck管鞘膜积液是理想的,因为它提供了出色的术中病理和术后结局。在所有情况下预防性放置网片可以帮助防止在这些情况下将来发生腹股沟疝。
BACKGROUND: Hydrocele of the canal of Nuck is a condition that arises due to incomplete obliteration of the processus vaginalis or an abnormal outpouching from the round ligament during fetal development. It usually presents as a painless, rarely painful, groin swelling. The definitive diagnosis for this condition is magnetic resonance imaging. Various management options have been proposed for this condition, including open surgery, transabdominal preperitoneal approach, totally extraperitoneal approach, and a combination of laparoscopic and open surgery. The present study highlights the benefits of the transabdominal preperitoneal approach when compared with the open anterior approach and addresses the intraoperative challenges faced during laparoscopic surgery.
METHODS: The study is a retrospective study inclusive of 20 patients who underwent surgery for the hydrocele of the canal of Nuck from June 2019 to December 2023. Case records of patients were studied for information such as demographic features, type of pathology, the surgery performed, intraoperative challenges encountered, operative time, duration of hospital stay, scores from the visual analog scale pain assessment chart at various intervals, and time taken to return to work. The variables were documented and statistically analyzed.
RESULTS: The average age group of the study population was 27.8 ± 8.34 years. Of the 20 patients, 10 had undergone a transabdominal preperitoneal approach (Group A), and 10 had undergone an open anterior approach (Group B). Eleven out of 20 patients had an associated inguinal hernia, of which three were identified preoperatively and eight were identified incidentally during surgery. The mean operative time of Group A cases was 97.95 ± 7.54 minutes, while it was 66.3 ± 6.20 minutes for Group B cases. The Mann-Whitney U test showed a statistically significantly lesser operative time for Group B than for Group A (p-value < 0.001). The duration of hospital stays was comparable for the two groups with no significant difference (two days versus 3.8 ± 3.08 days, respectively). When the difference in the means of time taken to return to normal work was compared using the Mann-Whitney U test between Group A and B (6.1 ± 0.87 days and 11.2 ± 1.81 days, respectively), a statistically significant early return to normal work in the former group (p-value = 0.001) was revealed. Similarly, the Mann-Whitney U test when used to compare the median postoperative pain score of both groups at 12-24 hours, 48-72 hours, seven days, and three months showed a significantly lesser pain score among patients of Group A at all intervals (p-value < 0.001, p-value = 0.005, p-value = 0.005, p-value < 0.001, respectively). The incidence of intraoperative challenges, sero-hematoma, and surgical site infection were insignificant in comparison.
CONCLUSIONS: The transabdominal preperitoneal approach for the hydrocele of the canal of Nuck is ideal as it offers excellent intraoperative delineation of pathology and postoperative outcomes. Prophylactic placement of a mesh in all cases can help prevent a future occurrence of inguinal hernia in these cases.