腹腔镜完全腹膜外疝修补术对精索血管和睾丸功能的影响

Influence of the laparoscopic totally extraperitoneal inguinal hernia repair on the blood supply and function of the testicle in male patients

目的探讨腹腔镜完全腹膜外疝修补术(TEP)对男性患者术后精索血管和睾丸睾丸功能的影响。方法选取2013年4月至2014年4月,河北医科大学第二医院行TEP疝修补术34例男性患者的临床资料。本组患者均为单侧疝,分别于术前1天、术后4和24周进行血液指标检测及双侧生殖系统超声检查,比较患者白细胞计数、血清睾酮浓度、双侧睾丸温度、双侧睾丸容积(TV)、双侧睾丸的睾丸动脉管径、流速[收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)]、血管阻力指数(RI)、双侧精索静脉管径、流速等指标。结果本组共34例手术全部完成,2例于术后24周时失访,其余患者检查资料收集完整。患者术后4周血常规中白细胞计数高于术前(P<0.05),而术后24周血常规中白细胞计数与术前相比其差异无统计学意义(P>0.05),术后4周血清睾酮浓度与术前比较其差异无统计学意义(P>0.05),术后24周血清睾酮浓度与术前比较其差异也无统计学意义(P>0.05),患侧睾丸大小、温度、睾丸动、静脉血流和管径等观测指标在术后4周、24周同术前相比较,其差异无统计学意义(P>0.05),患侧和健侧睾丸大小、温度、睾丸动、静脉等观测指标在术前、术后4周、24周相比较,其差异无统计学意义(P>0.05)。结论 TEP手术对男性的精索血管和睾丸功能无明显影响,是安全、可行的。

Objective To explore the influence of laparoscopic totally external inguinal hernia repair （TEP） on the blood supply and function of the testicle in male patients. Methods There were 34 male patients with unilateral inguinal hernia using TEP method, the blood test and ultrasound for reproductive system of patients were conducted on the day before operation, the 4th and the 24th week after operation respectively in the Second Hospital of Hebei Medical University from April 2013 to April 2014. The indexes included the WBC in blood routine, the concentration of serum testosterone, the testicular temperature, the testicular volume （ TV）, the diameter of testicular artery E the systolic peak of blood flow velocity （PSV）, the end-diastolic blood flow velocity （EDV）], the resistance index （RI） in testicular artery and the diameter and flow velocity of spermatic vein and so on. Results All the 34 cases were successfully operated, but there were two cases lost follow-up at the 24th weeks after the operation, the data of the other patients was collected. The WBC at the 4th week after operation was higher than that of the day before operation （ P 〈 0.05 ）, but there was no statistical significant difference between the WBC at the 24th week after operation and the day before operation （ P 〉 0.05 ）. The concentration of serum testosterone at the day before operation and the 4th week after operation did not exist significant difference （ P 〉 0.05 ） , the same condition also existed at the day before operation and the 24th week after operation （ P 〉 0.05 ） ; there were no statistical significant differences in the data of the testicular temperature, the testicular volume, the diameter of testicular artery, the diameter and flow velocity of spermatic vein and so on in the affected side among the day before operation, the 4th week and the 24th week after operation （ P 〉 0.05 ） ; all the dataalso did not exist statistical significant difference between the affected side and the unaffected side at the day before operation , the 4＇h week and the 24th week after operation （ P 〉 0.05 ）. Conclusions The TEP operation is safe and viable, and it has no significant influence on the blood supply and function of the testicle in male patients.