腹腔镜完全腹膜外疝修补术对睾丸血流及血清睾酮的影响

The influence of total extraperitoneal herniorrhaphy on testicular blood flow and serum testosterone

目的初步探讨腹腔镜完全腹膜外无张力腹股沟疝修补术(TEP)对睾丸血流及血清睾酮的影响。方法对我科住院行手术治疗的男性单侧腹股沟疝患者进行前瞻性研究,应用高频彩超对行腹腔镜下腹股沟疝修补的男性患者在术前48 h内,术后48 h内、2周内、1个月内用彩色超声分别测定患者患侧和对侧精索动脉血流量,包括收缩期峰值血流速度(PSV)和舒张末期血流速度(EDV)和睾丸体积,以及检测血清睾酮水平。结果共66例最终被选择入组。术前48 h内,患侧和对侧的PSV、EDV和睾丸体积差异均无明显异常(P>0.05);术后48 h及术后两周均检测到患侧的PSV、EDV和睾丸体积明显小于对侧,差异具有统计学意义(P<0.05)。而术后1个月内,患侧和对侧的PSV、EDV和睾丸体积差异均无统计学意义(P>0.05)。术前48 h内,术后48 h内、2周内及1个月的患者血浆睾酮水平的差异无统计学意义(P>0.05)。结论 TEP术治疗腹股沟疝时,术后早期(2周内)可降低患侧的睾丸血流和睾丸体积,但术后1个月可恢复正常;TEP术对腹股沟疝患者的血清睾酮无明显影响。不需进行干预。

Objective To investigate the totally extraperitoneal laparoscopic tension-free inguinal hernia repair （TEP） and its influence on testicular hemodynamics. Methods Sixty-six cases with unilateral inguinal hernia were enrolled in a prospective internally controlled cohort study, and were performed totally laparoscopic extraperitoneal tension-free inguinal hernia repair （TEP）. Pre- and post-operative blood flow parameters of bilateral testicular arteries, including peak systolic velocity （PSV）, end diastolic velocity （EDV）, testicular volume and plasma testosterone level were studied and compared. Results In pre-operation of 48 hours, there were no statistical differences in PSV, EDV and testicular volume between the both side （all P values〉0.05）. In post-operation of 48 hours and two weeks after operation,PSV、EDV and testicular volume of the affected side were significantly lower than that of the other side （all P values 〈0.05）. PSV, EDV and testicular volume were not significantly different in one month after operation. There were no statistically significant differences in plasma testosterone level in pre-operation of 48 hours, post-operation of 48 hours, 2 weeks after operation and one month after operation. Conclusion Testicular hypotension occurred in two weeks after TEP procedure on the affected side, and improved in 1 month later. Plasma testosterone level were not influenced.