IPOM与TEP患者围手术期精索睾丸超声检测对比

Perioperative spermatic cord and testicular evaluation by color doppler ultrasonography: IPOM vs.TEP inguinal hernia repair

目的观察腹膜内置网修补法(IPOM)及完全腹膜外疝修补术(TEP)术后对男性患者术侧精索睾丸结构的影响。方法选择2012年1月至2013年10月深圳市人民暨南大学医学院附属二院接受IPOM与TEP的男性单侧腹股沟疝患者,各20例,均为单侧原发腹股沟斜疝。比较术前,术后1、3个月患侧精索睾丸动脉最大血流速(Vmax)、精索静脉曲张程度(轻度/中度/重度)、睾丸体积大小(cm3)。结果术前二组睾丸动脉最大血流速、睾丸体积,二组比较差异无统计学意义;与术前比较,术后1、3个月二组睾丸动脉最大血流速、睾丸体积差异无统计学意义。术前二组各有1例轻度精索静脉曲张,术后1个月TEP组新增1例轻度精索静脉曲张病例,术后3个月新增患者缓解。IPOM组手术前后精索静脉曲张情况无变化。结论 IPOM对患者围手术期精索睾丸动脉最大血流速、精索静脉曲张程度以及睾丸体积均无明显影响,TEP对患者睾丸体积围手术期未见影响,对精索睾丸动脉最大血流速及精索静脉回流影响较小,术后3个月可恢复术前水平。

Objective To evaluate the effects of IPOM and TEP repair to the spermatic cord structure and testicle in male inguinal patients. Methods A total of 40 male patients with primary unilateral inguinal hernia who underwent IPOM and TEP repair in Shenzhen People＇s Hospital （20 cases in each group）, from January 2012 to October 2013, were enrolled in this study. With Doppler, spermatic and testicular parametersin operative side, were evaluated preoperatively and at 1 month, 3 months after the operation, and noted as theartery maximum flow velocity （Vmax）, degree of varicocele （mild/moderate/ severe） ,and testicular volume （ cm^3 ）. Results There were no significant differences between two groups preoperatively,comparing artery flow velocity, degree of varieocde and testieular volume. When compared with perioperative Vmax and testicularvolume, the values at 1 month or 3 months after surgery were not different between the groups. Each group had a case of mild varieocele before surgery, while a new varieocele was found in Group TEP at 1 month after the operation, then it was improved at 3 months. No changes of varieeeele cases in Group IPOM were found. Conclusions The maximum flow velocity of testicular artery, degree of varieocele and testieularvolume demonstrated no changes in patients underwent IPOM. But the Vmax and spermatie vein reflux are lightly impacted by TEP, then recovered to peroperative level at 3 months after surgery.