Clinical Study of the Impact of Totally Laparoscopic Extraperitoneal Inguinal Hernia Repair on Testicular Perfusion and Volume_West China Medical Journal

Authors：

SONG Xuemin , HUANG Shifeng

Department of General Surgery of the Fourth Hospital Affiliated to Guangxi Medical University, Liuzhou, Guangxi 545005, P. R. China;

Corresponding author：

Keywords：

腹腔镜; 完全腹膜外疝修补术; 睾丸

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目的　研究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。方法　2009年7月－2011年5月，对62例行完全腹膜外腹腔镜单侧腹股沟疝修补术男性患者进行自身前后对照研究，比较术前、术后患侧睾丸的睾丸动脉（TA）、睾丸包膜动脉（CA）、睾丸内动脉（ITA）血流参数[收缩期峰值血流速度（PSV）、舒张未期血流速度（EDV）及血管阻力指数（RI）]、睾丸体积（TV）及血清睾酮的变化情况。结果　患者获随访7～24个月，平均15.6个月，无复发患者。术前及术后3、6个月时患侧TV分别为（9.91 ± 3.72）、（10.23 ± 4.18）和（10.16 ± 3.94）cm3，同期血浆睾酮水平分别为（544.25 ± 123.72）、（532.89 ± 145.66）和（565.65 ± 138.13）μg/L，手术前后比较患侧TV（F=1.350，P=0.263）、血浆睾酮水平（F=1.673，P=0.192）无统计学意义，血浆睾酮水平均在正常范围内。术后3、6个月患侧TA、CA和ITA的EDV明显高于术前，RI较术前明显降低，差异均有统计学意义（P＜0.05）；PSV与术前比较差异无统计学意义（P＞0.05）。术后3个月患侧睾丸各动脉PSV、EDV、RI与术后6个月比较差异无统计学意义（P＞0.05）。结论　完全腹膜外腹腔镜腹股沟疝修补术后患侧睾丸血流灌注情况可能会有所改善，不影响TV及血清睾酮水平。

Citation： SONG Xuemin,HUANG Shifeng. Clinical Study of the Impact of Totally Laparoscopic Extraperitoneal Inguinal Hernia Repair on Testicular Perfusion and Volume. West China Medical Journal, 2012, 27(7): 1011-1014. doi: Copy

1.	McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc, 1993, 7(1): 26-28.
2.	Singh AN, Bansal VK, Misra MC, et al. Testicular functions， chronic groin pain， and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial[J]. Surg Endosc, 2012, 26(5): 1304-1317.
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4.	Sucullu I， Filiz AI， Sen B， et al. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study[J]. Hernia, 2010, 14(2): 165-169.
5.	韩振藩, 师其智.男性生殖系外科[M].北京:人民卫生出版社, 1989: 34-35.
6.	Koksal N, Altinli E, Sumer A, et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study[J]. Surg Laparosc Endosc Percutan Tech, 2010, 20(3): 186-189.
7.	Celik AS, Memmi N, Celebi F, et al. Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia[J]. Am J Surg, 2009, 198(2): 287-291.
8.	Tarhan S, Ucer O, Sahin MO，et al. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow[J]. J Androl, 2011, 32(1): 33-39.
9.	Koksal N, Altinli E, Sumer A, et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study[J]. Surg Laparosc Endosc Percutan Tech, 2010, 20(3): 186-189.
10.	Mihmanli I, Kantarci F, Kulaksizoglu H, et al. Testicular size and vascular resistance before and after hydrocelectomy[J]. AJR Am J Roentgenol, 2004, 183(5): 1379-1385.
11.	Turgut AT, Unsal A, Ozden E, et al. Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testiculargeometry and resistivity indices[J]. J Ultrasound Med, 2006, 25(7): 837-843.
12.	Orth RC, Towbin AJ. Acute testicular ischemia caused by incarcerated inguinal hernia[J]. Pediatr Radiol, 2012, 42(2): 196-200.
13.	Waseem M, Pinkert H, Devas G. Testicular infarction becoming apparent after hernia reduction[J]. J Emerg Med, 2010, 38(4): 460-462.
14.	Akbulut G, Serteser M, Yücel A, et al. Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial[J]. Surg Laparosc Endosc Percutan Tech, 2003, 13(6): 377-381.
15.	Schier F, Turial S, Hückstädt T, et al. Laparoscopic inguinal hernia repair does not impair testicular perfusion [J]. J Pediatr Surg, 2008, 43(1): 131-125.

1. 　McKernan JB, Laws HL. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J]. Surg Endosc, 1993, 7(1): 26-28.
2. 　Singh AN, Bansal VK, Misra MC, et al. Testicular functions， chronic groin pain， and quality of life after laparoscopic and open mesh repair of inguinal hernia: a prospective randomized controlled trial[J]. Surg Endosc, 2012, 26(5): 1304-1317.
3. 　李建文, 张云.腹腔镜和开放式腹股沟疝修补术的合理选择[J].腹腔镜外科杂志, 2011, 16(1): 6-9.
4. 　Sucullu I， Filiz AI， Sen B， et al. The effects of inguinal hernia repair on testicular function in young adults: a prospective randomized study[J]. Hernia, 2010, 14(2): 165-169.
5. 　韩振藩, 师其智.男性生殖系外科[M].北京:人民卫生出版社, 1989: 34-35.
6. 　Koksal N, Altinli E, Sumer A, et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study[J]. Surg Laparosc Endosc Percutan Tech, 2010, 20(3): 186-189.
7. 　Celik AS, Memmi N, Celebi F, et al. Impact of slit and nonslit mesh technique on testicular perfusion and volume in the early and late postoperative period of the totally extraperitoneal preperitoneal technique in patients with inguinal hernia[J]. Am J Surg, 2009, 198(2): 287-291.
8. 　Tarhan S, Ucer O, Sahin MO，et al. Long-term effect of microsurgical inguinal varicocelectomy on testicular blood flow[J]. J Androl, 2011, 32(1): 33-39.
9. 　Koksal N, Altinli E, Sumer A, et al. Impact of herniorraphy technique on testicular perfusion: results of a prospective study[J]. Surg Laparosc Endosc Percutan Tech, 2010, 20(3): 186-189.
10. 　Mihmanli I, Kantarci F, Kulaksizoglu H, et al. Testicular size and vascular resistance before and after hydrocelectomy[J]. AJR Am J Roentgenol, 2004, 183(5): 1379-1385.
11. 　Turgut AT, Unsal A, Ozden E, et al. Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testiculargeometry and resistivity indices[J]. J Ultrasound Med, 2006, 25(7): 837-843.
12. 　Orth RC, Towbin AJ. Acute testicular ischemia caused by incarcerated inguinal hernia[J]. Pediatr Radiol, 2012, 42(2): 196-200.
13. 　Waseem M, Pinkert H, Devas G. Testicular infarction becoming apparent after hernia reduction[J]. J Emerg Med, 2010, 38(4): 460-462.
14. 　Akbulut G, Serteser M, Yücel A, et al. Can laparoscopic hernia repair alter function and volume of testis? Randomized clinical trial[J]. Surg Laparosc Endosc Percutan Tech, 2003, 13(6): 377-381.
15. 　Schier F, Turial S, Hückstädt T, et al. Laparoscopic inguinal hernia repair does not impair testicular perfusion [J]. J Pediatr Surg, 2008, 43(1): 131-125.

West China Medical Journal

Clinical Study of the Impact of Totally Laparoscopic Extraperitoneal Inguinal Hernia Repair on Testicular Perfusion and Volume

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