腹股沟斜疝修补术后精液质量异常的相关因素分析

Analysis of related factors of abnormal semen quality after indirect inguinal hernia repair

目的观察男性腹股沟斜疝患者行腹腔镜疝修补术(laparoscopic inguinal hernia repair,LIHR)后精液质量异常情况,并分析其影响因素。方法选取2018年1月-2019年12月于我院接受LIHR术治疗的腹股沟斜疝男性患者为研究对象。术后开展1年随访,根据精液质量是否出现异常,将研究对象分为正常组(n=103)和异常组(n=21),对比两组患者术前及术后3月精液质量;分析两组的临床资料,以Cox回归分析LIHR术后精液质量异常的危险因素。构建列线图预测模型,并绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)评估列线图模型的预测能力。结果与正常组相比,异常组术后第3月的精液质量下降显著(P<0.05);两组患者补片类型,疝囊直径,疝部位及术中出血量的差异有统计学意义(P<0.05)。多因素Cox回归分析结果显示,合成补片,疝囊直径≥2 cm,双侧疝是男性腹股沟斜疝LIHR术后精子质量异常的独立危险因素。基于3个独立危险因素构建的列线图模型拟合效果良好,ROC曲线下面积为0.847(0.833-0.861),表明具有较强的预测能力。结论男性腹股沟斜疝患者行LIHR术有导致患者精子质量短期下降的风险,而采用合成补片、疝囊双侧和疝囊较大是LIHR术后精子质量下降的独立危险因素。

Objective To observe the abnormality of semen quality in male patients with indirect inguinal hernia after laparoscopic inguinal hernia repair(LIHR)and analyze its influencing factors.Methods Male patients with indirect inguinal hernia who underwent LIHR surgery in our hospital from January 2018 to December 2019 were selected as the research objects.The situation of abnormal semen quality within 1 year after surgery was counted.According to whether the semen quality was abnormal,the study subjects were divided into normal group(n=103)and abnormal group(n=21),and the semen quality of the two groups before and 3 months after the operation was compared;the clinical data of the two groups were analyzed,and the risk factors of abnormal semen quality after LIHR were analyzed by Cox regression.Construct a nomogram prediction model,whose predictive ability was evaluated by receiver operating characteristic curve(ROC).Results Compared with the normal group,the semen quality of the abnormal group decreased significantly in the third month after surgery(P<0.05);the difference of patch type,hernia sac diameter,hernia location and intraoperative blood loss between two groups was statistically significant(P<0.05).The results of multivariate Cox regression analysis showed that synthetic patch,hernia sac diameter≥2 cm,bilateral hernias were independent risk factors of abnormal semen quality after LIHR for the men with indirect inguinal hernia.The nomogram model constructed based on 3 independent risk factors had good fitting effect,and the area under the ROC curve was 0.847(0.833-0.861),indicating that it had strong predictive ability.Conclusion LIHR surgery for male indirect inguinal hernia was at risk of abnormal semen quality.Synthetic patches,bilateral hernia sacs and large hernia sacs were independent risk factors for abnormal semen quality after LIHR.