腹腔镜完全腹膜外腹股沟疝修补术后睾丸动脉血流灌注的影响因素分析

Influence factors analysis of testicular artery perfusion after laparoscopic totally extraperitoneal prosthetic

目的初步探讨腹腔镜完全腹膜外腹股沟疝修补术(TEP)后睾丸动脉血流灌注恢复情况及其影响因素。方法选择2013年9月至2016年6月江门市中心医院接受TEP手术的43例男性单侧腹股沟疝患者,按照年龄、体质量指数(BMI)、病程及手术时长分组,比较术前2 d、术后2 d、术后2周及术后1月的患侧睾丸动脉的收缩期峰值血流速度(PSV)和舒张末期血流速度(EDV)。结果重复测量方差分析提示年龄分组与手术时长分组的术后睾丸动脉血流灌注在对应各个时间点间差异有统计学意义。多因素分析显示年龄和手术时长均与时间存在交互作用,说明时间因素的作用随分组的不同而不同。对TEP术后1月睾丸动脉血流灌注是否恢复术前水平行差异性检验,结果显示术后睾丸动脉血流恢复情况与年龄及手术时长有关,而与BMI和病程无关。其中,多因素Logistics回归分析提示年龄与手术时长均为影响患者TEP术后睾丸动脉血流灌注恢复的独立危险因素(OR=1.102、1.102,P=0.005、0.006,95%CI:1.030~1.180、1.028~1.182)。结论年龄较大、手术时间较长的患者在行TEP术后睾丸动脉血流灌注需要更长时间恢复至术前水平。

Objective To investigate the influence factors of testicular artery perfusion after laparoscopic totally extraperitoneal inguinal prosthetic （TEP）. Methods A total of forty-three male patients with primary unilateral inguinal hernia who undei^cent TEP in Jiangmen Central Hospital from September 2013 to June 2016 were enrolled in this study. Pre- and post-operative testicular artery perfusion, peak systolic velocity （PSV） and end diastolic velocity （EDV）, were detected and compared in each group including age, body mass index （BMI）, disease duration and operation time. Results Repeated measurement ANOVA showed that testicular artery perfusion after TEP had significantly differences in every measurement time in group age and operative duration, and there was also interaction between time effect and group effects. Postoperative testicular artery perfusion recovering to preoperative condition was related to age and operative duration significantly, but not to BMI and disease duration. Besides, multivariate Logistics regression analysis showed that age and operative duration were independent risk factors for the recovery of testicular artery peffusion ＇after TEP operation （OR=1.102, 1.102, P=0.005, 0.006, 95%CI： 1.030-1.180, 1.028-1.182）. Conclusion After laparoscopic totally extraperitoneal inguinal prosthetic, testicular artery perfusion of patients with older age or undergoing longer operative duration need more time to recover to preoperative condition.