不同类型疝网片对大鼠睾丸组织及精子质量的影响

Effects of different hernia meshes on the testicular tissue and quality of sperm

目的:建立大鼠实验动物模型,对比在开放性无张力疝修补术中应用轻型、重型聚丙烯网片、膨体聚四氟乙烯网片对大鼠睾丸组织及精子质量的影响,为临床恰当选择疝网片材料提供理论依据。方法:将40只成年雄性大鼠随机分成5组,每组8只,分别为正常对照组(NC)、假手术组(FO)、重型聚丙烯网片组(PP)、膨体聚四氟乙烯网片组(e-PTFE)和轻型聚丙烯网片组(UP),后4组均施开放性无张力疝修补术。术后90d观察大鼠腹股沟区粘连程度;石蜡切片观察睾丸组织和输精管的病理变化;流式细胞仪检测各级生精细胞的水平;取附睾内精液检测大鼠精子活力。结果:各组术后一般情况良好。e-PTFE组疝网片与精索无粘连或轻度粘连,粘连面积<25%,UP、PP组疝网片与精索粘连较严重,粘连面积>50%;UP、PP组睾丸组织、输精管发生明显病理变化,单倍体生精细胞的数量显著减少。UP组(37.97%±10.24%)和PP组(37.25%±11.54%)a+b级精子百分比显著低于FO组(69.83%±8.83%)和NC组(80.32%±4.33%),P均<0.05。而e-PTFE组a+b级精子百分比(63.90%±6.23%)及其他各项指标与FO组、NC组相比差异无统计学意义(P均<0.05)。结论:在开放性无张力疝修补术中使用的疝网片对雄性大鼠的生殖功能有一定影响,不同材料疝网片对雄性大鼠的生殖功能影响不同。轻型、重型聚丙烯网片的影响较大,膨体聚四氟乙烯网片影响较小。建议在今后的临床中对于必须行无张力疝修补术者,使用膨体聚四氟乙烯网片较为合适。

Objective：To compare different effects of light-weight polypropylene （UP）,heavy-weight polypropylene （PP）,and expanded polytetrafluoroethylene （e-PTFE） meshes on the testicular tissue and the quality of sperm in the open tension-free hernioplasty.Methods：Forty male SD rats were randomly divided into 5 groups.Eight rats were assigned to certain groups that included the normal control group （NC）,sham operation group （FO）,PP mesh group,UP mesh group and e-PTFE mesh group.Rats in the latter four groups were experienced the tension-free hernioplasty with hernia meshes.The general state and the degree of adhesion of the spermatic cord around meshes in each group were observed on the 90th day after the operation.HE staining was used to observe the pathological changes of the testicular tissue; and the spermatogenic cell were quantitatively measured by flow cytometry.Meanwhile,the percentage of grade a＋b sperm from the epididymis was evaluated by the semen routine testing.Results：The postoperative general states in 5 groups were all well.The degrees of adhesion were unobservable or mild in e-PTFE group （＜25 ％） but severe in UP and PP （＞50％） groups between the hernia mesh and the spermatic cord.Obvious pathological changes of testis and testicular ducts as well as less haploid spermatogenic cells were found in UP and PP groups.The percentages of grade a＋ b sperm of UP （37.97 ％ ± 10.24 ％） and PP （37.25 ％ ± 11.54％） groups were significantly lower than those of FO （69.83％±8.83％） and NC （80.32％±4.33％） groups （P all ＜ 0.05）.There were no statistically significant difference in the percentage of grade a＋b sperm and other indicators between ePTFE （63.90 ％ ± 6.23 ％） group and NC/FO group （P all ＜0.05）.Conclusion：The influence on the reproductive function ofmale rats is obvious when applying the tension-free hemioplasty with hernia meshes.The effects varies from different types of meshes that UP and PP have a great influence while e-PTFE has a slight one.Despite it is recommend to avoid from tensionfree hernioplasty with hernia meshes,the necessary application of e-PTFE mesh is acceptable when the surgery is obligatory.