腹腔镜经腹腹膜前修补术对睾丸血供及生精功能影响的临床研究

doi:10.3969/j.issn.1009-976X.2020.04.017

摘要/Abstract

摘要： 目的观察腹经腹腹膜前修补术对睾丸血供及生精功能影响。方法 2017年6月~2019年1月,收集在医院行腹腔镜经腹腹膜前修补术患者,共41例,比较其术前、术后7天、术后6月精子浓度、精子活力、血清卵泡刺激素（FSH）、血清抑制素B（IHN-B）、睾丸体积、睾丸动脉收缩期峰值血液流速（PSV）的差异。结果与术前相比,术后7天及术后6月精子浓度、精子活力、血清卵泡刺激素、血清抑制素B、睾丸体积均无明显差异,而PSV在术后6天较术前有明显降低,差异有统计学意义,而术后6个月差异无统计学意义。术后血肿、手术时间延长是术后睾丸血供异常的风险因素。结论经腹腹膜前修补术对睾丸生精功能无显著影响。

关键词: 精子浓度, 睾丸体积, 腹腔镜经腹腹膜前修补术, 血流灌注, 血清卵泡刺激素, 精子活力, 血清抑制素B

Abstract: Objective To clinical study on testicular blood supply and spermatogenic function during transabdominal preperitoneal repair （TAPP）. Methods A total of 41 cases received from June 2017 to January 2019 in this hospital on TAPP were collected. The sperm concentration, sperm motility, serum follicle stimulating hormone （FSH）, serum inhibin B, testicular volume and peak systolic velocity （PSV） of testicular artery were compared before, 7 days and 6 months after operation. Results There was no significant differences in sperm concentration, sperm motility, FSH, serum inhibin B and testis volume between the patients 7 days and 6 months after operation, the levels of PSV of testis artery of patients at 7 days after operations was significantly different from those before and 6 months after operation. Postoperative hematoma and prolonged operation time are risk factors of abnormal testicular blood supply. Conclusion TAPP has no significant effect on testicular spermatogenesis.

Key words: TAPP, blood perfusion, testicular volume, FSH, inhibin B, sperm concentration, sperm motility

中图分类号:

R656.2+

仵永泉, 石毅军, 邓静, 张周文, 张彩云. 腹腔镜经腹腹膜前修补术对睾丸血供及生精功能影响的临床研究[J]. 岭南现代临床外科, 2020, 20(04): 480-483.

WU Yong-quan, SHI Yi-jun, DENG Jing, ZHANG Zhou-wen, ZHANG Cai-yun. Clinical study on testicular blood supply and spermatogenic function during laparoscopic transabdominal preperitoneal repair[J]. Lingnan Modern Clinics in Surgery, 2020, 20(04): 480-483.

参考文献

[1] Junge K, Binnebsel M, Kauffmann C, et al.Damage to the spermatic cord by the Lichtenstein and TAPP procedures in a pig model[J]. Surg Endosc, 2011, 25(1): 146-152.
[2] Pepe P, Panella P, Pennisi M, Aragona F.Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?[J]. Eur J Radiol, 2006, 60(1): 120-124.
[3] Holloway BJ, Belcher HE, Letourneau JG, et al.Scrotal sonography: A valuable tool in the evaluation of complications following inguinal hernia repair[J]. J Clin Ultrasound, 1998, 26(7): 341-344.
[4] World Health Organization.WHO laboratory manual for the examination and processing of human semen [M]. 5th ed. London: Cambridge University Press, 2010.
[5] Shin D, Lipshultz LI, Goldstein M, et al.Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia[J]. Ann Surg, 2005, 241(4): 553-558.
[6] Maciel LC, Glina S, Palma PC, et al.Histopathological alterations of the vas deferens in rats exposed to polypropylene mesh[J]. BJU Int, 2007, 100(1):187-190.
[7] Peiper C, Junge K, Klinge U, et al.Is there a risk of infertility after inguinal mesh repair?Experimental studies in the pig and the rabbit[J]. Hernia, 2006, 10(1): 7-12.
[8] 徐浩, 陈明, 吴丽英, 等. 不同类型疝网片对大鼠睾丸组织及精子质量的影响[J]. 中国计划生育学杂志, 2014, (9): 589-593.
[9] 宓立强, 陈明, 邱志东, 等. 轻型与重型聚丙烯网片对大鼠睾丸间质细胞凋亡的影响[J]. 中华疝和腹壁外科杂志(电子版), 2013, (1):30-34.
[10] Di Vita G, D'Agostino P, Patti R, et al. Acute inflammatory response after inguinal and incisional hernia repair with implantation of polypropylene mesh of different size[J]. Langenbecks Arch Surg, 2005, 390(4): 306-311.
[11] 林启谋, 李勇, 周毅. 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[J]. 岭南现代临床外科, 2016, 16(4): 460-464.
[12] Bulus H, Dogan M, Tas A, et al.The effects of Lichtenstein tension-free mesh hernia repair on testicular arterial perfusion and sexual functions[J]. Wien Klin Wochenschr, 2013, 125(3-4): 96-99.
[13] Peeters E, Spiessens C, Oyen R, et al.Sperm motility after laparoscopic inguinal hernia repair with lightweight meshes: 3-year follow-up of a randomised clinical trial[J]. Hernia, 2014, 18(3): 361-367.
[14] 宋学民, 黄世锋. 完全腹膜外腹腔镜腹股沟疝修补术对睾丸血流灌注及体积的影响[J]. 华西医学, 2012, (7): 1011-1014.
[15] 李虹, 吴克华. 腹腔镜完全腹膜外腹股沟疝修补术对睾丸的影响[J]. 腹腔镜外科杂志, 2018, 23(5): 63-66.
[16] Tuncer AA, Peker T, Acar MB, et al.A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study[J]. Pak J Med Sci, 2017, 33(2): 363-368.
[17] Kordzadeh A, Liu MO, Jayanthi NV.Male infertility following inguinal hernia repair: a systematic review and pooled analysis[J]. Hernia, 2017, 21(1): 1-7.
[18] 刘小惠, 吴小华. 抑制素B在两性生殖生理和病理中的研究进展[J]. 生殖与避孕, 2016, 36(9): 737-744.