腹腔镜下疝囊高位结扎对兔输精管形态及通畅程度的影响

Effects of laparoscopic high ligation of hernia sac on morphology and patency of rabbit vas deferens

目的探讨不同疝囊高位结扎术式对输精管形态及通畅程度的影响。方法将30只健康雄性日本大耳白兔随机分为3组:传统疝囊高位结扎术(TO)组、腹腔镜下内环缝扎(IP)组和腹腔镜经皮腹膜外内环结扎(LPEC)组,麻醉后分别实施对应术式高位结扎双侧内环,术后14、28 d,各组随机抽取5只样本行输精管超声造影检查、腹腔镜探查内环口腹膜愈合情况及抗腹压程度,并取内环口组织行HE及Masson染色检查。结果3组手术操作顺利,无术中及术后意外死亡,术后无切口感染,无医源性隐睾或睾丸萎缩病例。TO组术后输精管有不同程度的折叠、扭曲,术后28 d样本中出现1例单侧输精管完全梗阻样本;IP组术后输精管不畅情况以局部狭窄为主;而LPEC组以输精管轻度成角为主。IP组和LPEC组术后均无输精管完全梗阻样本。3组术后输精管通畅评分比较差异有统计学意义(P均<0.05)。术后不同时间对评分影响不明显(P均>0.05),分组与术后时间的交互作用对术后输精管通畅评分影响不明显(P均>0.05)。所有样本术后腹腔镜探查时内环口腹膜均无肉眼可见缺损。升高气腹压力,IP组术后14 d样本中有3例分别在16、17和17 mmHg时出现一侧内环口腹膜漏气,余样本内环口腹膜均可承受≥20 mmHg气腹压力。病理学检查结果显示,TO组较另2组解剖层次紊乱,组织间隙界限不清。术后14、28 d,3组结扎线周围均出现明显的炎性细胞及成纤维细胞浸润,其中以TO组成纤维细胞浸润程度最显著,IP组与LPEC组程度相近,经图像分析软件半定量分析,三组间比较差异有统计学意义(P均<0.05)。结论与TO比较,IP和LPEC术式均对输精管形态结构影响轻微,手术安全、可靠、有效。其中,LPEC术式相较于IP术式内环结扎效果更为确切。

Objective To explore the effects of different high ligation of hernia sac methods on the morphology and patency of vas deferens.Methods Thirty healthy male rabbits were randomly divided into three groups:traditional operation(TO)group,intracorporeal purse suturing(IP)group,and laparoscopic percutaneous extraperitoneal closure(LPEC)group.Bilateral inner rings were high ligated by corresponding operation methods after anesthesia.On the 14th and 28th days after operation,5 samples were randomly selected from each group and examined by contrast-enhanced vas deferens ultrasonography.Laparoscopy was used to explore the peritoneal healing and anti-abdominal pressure degree of the inner ring orifice.The inner ring orifice tissues were taken and examined by HE and Masson staining.Results The operation of each experimental group was smooth,and there were no accidental death during and after operation,no incision infection,no iatrogenic cryptorchidism or testicular atrophy.The vas deferens in the TO group were folded and distorted to varying degrees after operation.One case of unilateral complete vas deferens obstruction appeared in the samples examined at 28 days after operation.In the IP group,local stenosis was the main manifestation of vas deferens obstruction after operation.In the LPEC group,the mainly cause was mild angulation after operation.No complete vas deferens obstruction was found in the IP group and LPEC group.There were significant differences in postoperative vas deferens patency scores between the three groups(all P<0.05).Different time after operation had no significant effect on the score(P>0.05),and the interaction between grouping and days after operation had no significant effect on the score of vas deferens patency after operation(all P>0.05).After laparoscopic exploration,the peritoneum of the inner ring orifice of all samples healed,and no defect was visible to naked eyes.Pneumoperitoneum pressure increased.In the IP group,on the 14 th day after operation,3 samples had air leakage at 16 and 17 and 17 mmHg,respectively,and the other samples could bear pneumoperitoneum pressure≥20 mmHg.Pathological examination showed that the anatomical level was obviously disordered in the TO group in comparison with the other two groups,and the boundary of tissue space was unclear.On the 14th and 28th days after operation,inflammatory cells and fibroblasts infiltrated around the ligature in all three groups.The fibroblast infiltration was the heaviest in the TO group,and the degree of the IP group was similar to that in the LPEC group.After the semi-quantitative analysis by image analysis software,the difference among the three groups was statistically significant(P<0.05).Conclusions Both IP and LPEC.have slight influence on the morphology and structure of vas deferens,and the operation is safe,reliable,and effective.Among them,LPEC is more effective than IP.