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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 497 -501. doi: 10.3877/cma.j.issn.1674-392X.2021.05.013

临床论著

腹腔镜完全腹膜外疝修补术对单侧腹股沟斜疝患者睾丸血流、睾酮水平和白细胞计数的影响
罗淇文1, 董永红2,†(), 林伟力1, 王梓良1, 徐钧3   
  1. 1. 030001　太原，山西医科大学
    2. 030001　太原，山西医科大学附属人民医院胃肠胰及疝与腹壁外科
    3. 030001　太原，山西医科大学第一医院普外科
  • 收稿日期:2020-06-09 出版日期:2021-10-14
  • 通信作者: 董永红

Effect on testicular blood flow, level of testosterone and leukocyte count in patients with unilateral indirect inguinal hernia using TEP

Qiwen Luo1, Yonghong Dong2,†(), Weili Lin1, Ziliang Wang1, jun Xu3   

  1. 1. Shanxi Medical University, Taiyuan 030001, China
    2. Department of Gastrointestinal Surgery, People's Hospital Affiliated to Shanxi Medical University, Taiyuan 030001, China
    3. Department of General Surgery, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2020-06-09 Published:2021-10-14
  • Corresponding author: Yonghong Dong
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罗淇文, 董永红, 林伟力, 王梓良, 徐钧. 腹腔镜完全腹膜外疝修补术对单侧腹股沟斜疝患者睾丸血流、睾酮水平和白细胞计数的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2021, 15(05): 497-501.

Qiwen Luo, Yonghong Dong, Weili Lin, Ziliang Wang, jun Xu. Effect on testicular blood flow, level of testosterone and leukocyte count in patients with unilateral indirect inguinal hernia using TEP[J/OL]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(05): 497-501.

目的

探讨腹腔镜完全腹膜外疝修补术（TEP）对单侧腹股沟斜疝患者睾丸血流、睾酮水平和白细胞计数的影响。

方法

选择2017年1月至2018年12月在山西医科大学附属人民医院行TEP术的96例单侧腹沟疝斜疝患者，收集患者相关临床资料。比较患者术前、术后3 d、3个月和6个月的睾丸体积、血浆睾酮水平、睾丸血流及白细胞计数。

结果

术前、术后3 d、3个月及6个月患者的睾丸体积及血浆睾酮水平均无显著变化（P>0.05）；术后3 d患者的白细胞水平较术前升高（P<0.05），术后3个月患者的白细胞计数较术后3 d下降（P<0.05），术后6个月患者的白细胞计数较术后3个月降低（P<0.05），而与术前相比差异无统计学意义（P>0.05）；术后3 d、3个月和6个月患者的睾丸内动脉（ITA）和睾丸动脉（TA）的血管阻力指数（RI）值均低于术前（P<0.05），且术后3个月ITA值低于术后3 d，术后6个月ITA的RI值低于术后3个月。术后3 d、3个月及6个月患者的睾丸包膜动脉（CA）的舒张末期血流速度值均高于术前，而CA的RI值均低于术前。术前术后TA、CA和ITA的动脉收缩期峰值血液流速值均无明显变化（P>0.05）。

结论

TEP手术治疗单侧腹沟斜疝患者，能改善患者睾丸血流灌注，不影响血浆睾酮水平，同时不会引发慢性炎症反应，安全可靠。

关键词: 腹股沟斜疝, 睾丸血流, 睾酮, 白细胞, 完全腹膜外疝修补术
Objective

To explore the effect on testicular blood flow, level of testosterone and leukocyte count in patients with unilateral indirect inguinal hernia using laparoscopic totally extraperitoneal repair (TEP).

Methods

96 patients with unilateral indirect inguinal hernia underwent TEP from January 2017 to December 2018 in our hospital were selected to collect the relevant clinical data. The testicular volume, level of plasma testosterone, testicular blood flow and leukocyte count were compared before operation, 3 day after operation, 3 months after and 6 months after operation.

Results

There were no significant changes in the testicular volume and levels of plasma testosterone before operation, 3 day after operation, 3 months after operation and 6 months after operation (P>0.05). 3 days after operation, the leukocyte count was higher than that before operation (P<0.05), 3 months after operation, the leukocyte count was higher than that 3 days after operation (P<0.05), and the leukocyte count in 6 months after operation was lower than that in 3 months after operation (P<0.05), but there was no significant difference compared with that before operation (P>0.05). 3 days after operation, 3 and 6 months after operation, the resistance index (RI) of internal testicular artery (ITA) and testicular artery (TA) were lower than that before operation (P<0.05), and the RI of ITA at 3 months after operation was lower than that at 3 days after operation (P<0.05), the RI of ITA at 6 months after operation was lower than that at 3 months after operation (P<0.05). 3days after operation, 3 months and 6 months after operation, the end-diastolic blood flow velocity (EDV) of testicular capsular artery (CA) were higher than that before operation, while the RI of CA was lower than that before operation (P<0.05). There were no significant changes in peak systolic blood flow velocity (PSV) of TA, CA and ITA before and after operation (P>0.05).

Conclusion

TEP procedure can improve testicular blood perfusion in patients with unilateral indirect inguinal hernia, without affecting the level of plasma testosterone and causing chronic inflammatory reaction, which is safe and reliable.

Key words: indirect inguinal hernia, testicular blood flow, testosterone, white blood cell, totally extraperitoneal repair
表1 手术前后患侧睾丸体积及血浆睾酮水平比较（）
时间 例数 血浆睾酮水平(μg/L) 睾丸体积(cm2)
术前 96 532.2±117.4 8.8±2.4
术后3 d 96 530.3±119.7 9.0±2.6
术后3个月 96 526.3±123.5 9.1±2.8
术后6个月 96 538.1±122.3 9.2±3.7
F值   0.114 0.229
P值   0.892 0.796
表2 手术前后患者白细胞计数变化及睾丸内动脉血流参数变化情况比较（±s）
时间 例数 白细胞计数(109/L) 睾丸内动脉
收缩期峰值血液流速(cm/s) 舒张末期血流速度(cm/s) 血管阻力指数
术前 96 5.2±0.3 4.5±0.6 2.6±0.4 0.4±0.1
术后3 d 96 9.6±1.6* 4.6±0.6 2.7±0.4 0.3±0.1*
术后3个月 96 6.3±0.4** 4.7±0.7 2.8±0.5 0.3±0.2*
术后6个月 96 5.4±0.2# 4.8±0.8 2.9±0.3 0.3±0.1*#
F值   170.483 0.966 2.880 8.000
P值   <0.001 0.383 0.059 <0.001
表3 手术前后患侧睾丸各动脉血流参数比较（±s）
时间 例数 睾丸动脉 睾丸包膜动脉
收缩期峰值血液流速(cm/s) 舒张末期血流速度(cm/s) 血管阻力指数 收缩期峰值血液流速(cm/s) 舒张末期血流速度(cm/s) 血管阻力指数
术前 96 10.5±2.6 4.3±1.2 0.6±0.1 6.6±1.3 2.8±0.5 0.6±0.1
术后3 d 96 10.6±2.5 4.7±1.1 0.5±0.1* 6.6±1.2 3.4±0.6* 0.5±0.1*
术后3个月 96 10.9±2.5 4.9±1.3 0.5±0.2* 6.7±1.2 3.3±0.7* 0.5±0.2*
术后6个月 96 10.7±2.4 4.6±1.4 0.5±0.1*# 6.8±1.3 3.2±0.6* 0.5±0.1*
F值   0.307 2.546 8.00 0.299 9.164 8.000
P值   0.736 0.082 0.000 0.742 0.000 0.001
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