Testicular hydrocele and orchiectomy

There are four types of hydrocele: 1 congenital hydrocele (traffic hydrocele), which is caused by incomplete closure of congenital peritoneal sheath; 2 spermatic hydrocele is spermatic cord Fluid in the capsular sac, but not in contact with the abdominal cavity and testicular sheath; 3 spermatic testicular hydrocele (infant hydrocele), is the sac in the spermatic sac, but not in the abdominal cavity The same; 4 testicular hydrocele, the peritoneal sheath is completely closed, but the testicular capsular sac is too much fluid. Clinically, testicular hydrocele is the most common. Testicular hydrocele is divided into primary and secondary. The primary is more common, the cause is still unclear. Secondary secondary scrotal trauma, non-specific infection of testicular epididymis, tuberculosis, tumor, scrotum parasitic diseases and surgery, also known as symptomatic hydrocele. Treatment of hydrocele, hydrocele in infants under 2 years of age can disappear on their own; adult hydrocele is small and asymptomatic can not be treated; testicular secondary hydrocele should be treated first. For smaller hydrocele, the method of post-puncture injection can be used, but the traffic hydrocele is forbidden; the larger hydrocele and the traffic hydrocele need to be treated surgically. Testicular choroidal resection is a common procedure for the treatment of testicular hydrocele, which removes the excess testicular sheath and then sutures the remaining sheath to the back of the testicular epididymis for suturing. It can also be used for testicular spermatic hydrocele and spermatic hydrocele. Treatment of diseases: testicular hydrocele Indication Testicular hydrocele and testicular sheath resection apply to: 1. Larger testicular hydrocele. 2. Large testicular spermatic hydrocele. 3. The spermatic hydrocele can be inverted to the rear of the spermatic cord if it cannot be completely removed. 4. Surgery of the contents of the scrotum, in order to prevent secondary effusion, can be performed at the same time. Contraindications The scrotal content of suppurative disease with hydrocele is only for drainage without resection. The scrotum has skin diseases such as eczema and femoral hernia. Preoperative preparation 1. Wash the scrotum, penis, groin and perineum with soapy water and water before surgery. Pay attention to the scrotum folds and wash. 2. Shave the pubic hair 1 day before surgery. Surgical procedure 1. Cut the scrotum wall and fix the scrotum with the left hand. The skin of the scrotum is stretched with a little pressure. The avascular area is selected as a longitudinal or transverse incision. The length depends on the size of the effusion. Cut the skin, the meat film and the fascia tissue to the sheath wall. 2. Separate the sheath sac and squeeze the testicles together with the capsular sac by hand to the incision. Use a vascular clamp to clamp a small gauze ball or finger wrap to gauze along the surface of the sheath wall layer and the cremaster muscle for blunt separation until the sheath can be The capsule is extruded outside the scrotal incision. If the capsular sac is too large, part of the effusion can be removed, and then the outer slit is separated and further separated along the wall of the sheath, and a small length of spermatic cord is released upward. 3. Incision of the capsular sac with 2 vascular clamps in the avascular zone to lift the sheath wall layer, cut in the anterior wall, and drain the liquid. The sac capsular sac is cut longitudinally to enlarge the incision. Check the testicular epididymis for lesions and explore the peritoneal sheath between the peritoneal cavity and the abdominal cavity. If there is no traffic, treat it with testicular hydrocele. 4. Excision of the sheath with scissors to cut off the excess sheath at 1.5 to 2.0 cm from the edge of the testis epididymis, the edge completely stop bleeding. The residual sheath wall was inverted to the back of the testicular epididymis, and the filaments were interrupted or sutured continuously. The residual sheath under the testicle is sutured to the meat membrane behind it to prevent the spermatic cord from twisting. 5. Place the drainage, suture the incision and carefully inspect the surgical field, completely stop the bleeding, and put the testicles into the scrotum. Make a small incision at the lower end of the incision or at the bottom of the scrotum, and place a rubber sheet for drainage. The scrotal meat film was sutured intermittently with a thin wire, and the scrotal skin was sutured vertically. 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. The spermatic cord is reversed: the residual sheath under the testicle is not sutured with the scrotal membrane, or the spermatic cord is twisted when the testicle is inserted into the scrotum. After the spermatic cord is twisted, the testicular blood supply is impaired, which can cause testicular necrosis. Postoperative patients developed severe testicular pain and tenderness, and had nausea and vomiting. The suture should be removed immediately and surgically reset and fixed; if the testicle is necrotic, the testicular is removed.

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