【摘要】：目的:探索Millikan疝修補(bǔ)手術(shù)對(duì)患者睪丸血流灌注及血清睪酮濃度的影響,對(duì)臨床上腹股溝疝患者采用無(wú)張力疝修補(bǔ)術(shù)式提供參考。資料:2013年10月至2014年4月,河北醫(yī)科大學(xué)第二醫(yī)院疝與腹壁外科收治并行Millikan疝修補(bǔ)手術(shù)的腹股溝疝男性患者35例,年齡為65±9歲,均為原發(fā)性單側(cè)腹股溝疝,其中斜疝29例(83%),直疝6例(17%)。所有患者均被告知本研究目的,并簽署知情同意書(shū)。方法:1手術(shù)方法:所有患者均擇期于局麻下行Millikan疝修補(bǔ)手術(shù),補(bǔ)片均采用意大利Herniamesh有限公司生產(chǎn)的赫美補(bǔ)片(聚丙烯網(wǎng)塞+平片),局麻藥采用利多卡因與羅哌卡因的混合液。找到疝囊,完整剝離疝囊至內(nèi)環(huán)口,切開(kāi)其內(nèi)側(cè)腹橫筋膜并充分游離周?chē)鼓で伴g隙。然后將帽狀網(wǎng)塞填充于內(nèi)環(huán)口處腹膜前間隙,并與周?chē)箼M筋膜固定3-4針,再將平片平鋪于精索后方的腹股溝管后壁,并與周?chē)M織縫合固定。將內(nèi)、外環(huán)重建后,需均可容術(shù)者小指尖順利通過(guò),來(lái)確保精索等結(jié)構(gòu)無(wú)張力通過(guò)�？p合線均采用3-0可吸收線。2研究時(shí)間及內(nèi)容:術(shù)前、術(shù)后1個(gè)月、術(shù)后6個(gè)月分別檢查:患側(cè)與健側(cè)的睪丸溫度、睪丸體積、精索靜脈內(nèi)徑、精索動(dòng)脈最大血流速、精索動(dòng)脈阻力系數(shù)及外周血清睪酮濃度。3結(jié)果處理及統(tǒng)計(jì)分析:應(yīng)用SPSS 19.0統(tǒng)計(jì)學(xué)軟件根據(jù)采集的實(shí)驗(yàn)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05為有統(tǒng)計(jì)學(xué)意義。結(jié)果:對(duì)35例進(jìn)行了Millikan疝修補(bǔ)手術(shù)的單側(cè)原發(fā)性腹股溝疝患者,進(jìn)行了長(zhǎng)達(dá)6個(gè)月的隨訪。術(shù)后1個(gè)月時(shí),有3例失訪,術(shù)后6個(gè)月時(shí),有6例失訪。疝環(huán)缺損大小平均2.5±0.8cm。手術(shù)順利,術(shù)中均無(wú)并發(fā)癥。對(duì)資料收集、整理后,利用SPSS 19.0處理,所有資料均符合正態(tài)分布,并且相關(guān)系數(shù)檢驗(yàn)P值0.05。于術(shù)前、術(shù)后1個(gè)月、術(shù)后6個(gè)月三個(gè)時(shí)間點(diǎn),分別將健側(cè)與患側(cè)的睪丸溫度、睪丸體積、精索靜脈內(nèi)徑、精索動(dòng)脈最大血流、精索動(dòng)脈阻力系數(shù)行配對(duì)t檢驗(yàn)。將患側(cè)睪丸溫度、體積、血流灌注及外周血睪酮濃度,分別于術(shù)前、術(shù)后1個(gè)月、術(shù)后6個(gè)月三個(gè)時(shí)間點(diǎn)間行均數(shù)的方差分析(one-way ANOVA),發(fā)現(xiàn)P值均≥0.05,均無(wú)統(tǒng)計(jì)學(xué)意義。具體如下:1術(shù)前健側(cè)與患側(cè)各指標(biāo)的對(duì)比情況:睪丸溫度健側(cè)(36.1±0.4℃)vs患側(cè)(36.1±0.5℃)、睪丸體積健側(cè)(10.8±2.1cm3)vs患側(cè)(10.9±2.0cm3)、精索靜脈內(nèi)徑健側(cè)(2.0±0.3mm)vs(2.0±0.3mm)、精索動(dòng)脈最大血流健側(cè)(13.2±2.7cm/s)vs患側(cè)(13.6±2.7cm/s)、精索動(dòng)脈阻力系數(shù)健側(cè)(0.76±0.06)vs患側(cè)(0.77±0.07),均行配對(duì)t檢驗(yàn),P值均≥0.05,無(wú)統(tǒng)計(jì)學(xué)意義。2術(shù)后1個(gè)月健側(cè)與患側(cè)各指標(biāo)的對(duì)比情況:睪丸溫度健側(cè)(36.1±0.4℃)vs患側(cè)(36.1±0.4℃)、睪丸體積健側(cè)(10.5±2.3cm3)vs患側(cè)(10.7±2.0cm3)、精索靜脈內(nèi)徑健側(cè)(2.0±0.4mm)vs患側(cè)(2.0±0.3mm)、精索動(dòng)脈最大血流健側(cè)(13.0±2.2cm/s)vs患側(cè)(13.3±2.0cm/s)、精索動(dòng)脈阻力系數(shù)健側(cè)(0.76±0.06)vs患側(cè)(0.77±0.06),均行配對(duì)t檢驗(yàn),P值均≥0.05,無(wú)統(tǒng)計(jì)學(xué)意義。3術(shù)后6個(gè)月健側(cè)與患側(cè)各指標(biāo)的對(duì)比情況:睪丸溫度健側(cè)(36.0±0.3℃)vs患側(cè)(36.0±0.3℃)、睪丸體積健側(cè)(10.6±1.9cm3)vs患側(cè)(10.8±2.0cm3)、精索靜脈內(nèi)徑健側(cè)(2.0±0.3mm)vs(2.0±0.3mm)、精索動(dòng)脈最大血流健側(cè)(12.7±2.6cm/s)vs患側(cè)(13.3±2.0cm/s)、精索動(dòng)脈阻力系數(shù)健側(cè)(0.75±0.06)vs患側(cè)(0.77±0.05),均行配對(duì)t檢驗(yàn),P值均≥0.05,無(wú)統(tǒng)計(jì)學(xué)意義。4患側(cè)各指標(biāo)于術(shù)前、術(shù)后1個(gè)月、術(shù)后6個(gè)月三個(gè)時(shí)間點(diǎn)間的對(duì)比情況:睪丸溫度術(shù)前(36.1±0.5℃)vs術(shù)后1月(36.1±0.4℃)vs術(shù)后6月(36.0±0.3℃)、睪丸體積術(shù)前(11.0±2.2cm3)vs術(shù)后1月(10.8±2.0cm3)vs術(shù)后6月(10.8±2.0cm3)、精索靜脈管徑術(shù)前(2.0±0.3mm)vs術(shù)后1月(2.0±0.3mm)vs術(shù)后6月(2.0±0.3mm)、精索動(dòng)脈最大流速術(shù)前(13.5±3.0cm/s)vs術(shù)后1月(13.3±2.1cm/s)vs術(shù)后6月(13.3±2.0cm/s)、患側(cè)精索動(dòng)脈阻力系數(shù)術(shù)前(0.77±0.08)vs術(shù)后1月(0.76±0.07)vs術(shù)后6月(0.77±0.05)、睪酮濃度術(shù)前(4.01±1.17ng/ml)vs術(shù)后1月(3.93±1.06ng/ml)vs術(shù)后6月(4.01±1.03ng/ml),均行均數(shù)的方差分析(one-way ANOVA),組間P值均≥0.05,均無(wú)統(tǒng)計(jì)學(xué)意義。結(jié)論:Millikan疝修補(bǔ)手術(shù)在短期內(nèi)對(duì)患者睪丸血流灌注及睪酮濃度沒(méi)有明顯影響,但長(zhǎng)期影響,尚需進(jìn)一步的觀察。
[Abstract]:Objective: To explore the effect of Millikan herniorrhaphy on testicular blood perfusion and serum testosterone concentration in patients with inguinal hernia, and to provide reference for clinical use of tension-free herniorrhaphy in patients with inguinal hernia. All patients were informed of the purpose of the study and signed informed consent. METHODS: 1. All patients underwent Millikan herniorrhaphy under local anesthesia. Herniamesh, Italy, was used as the patch. Hermione patch (polypropylene mesh plug + plain film) produced by the Department of local anesthesia using a mixture of lidocaine and ropivacaine. The hernia sac was found, the hernia sac was completely stripped to the inner ring orifice, the medial transverse fascia was incised and the surrounding anterior peritoneal space was fully free. Then the cap-shaped mesh plug was filled into the anterior peritoneal space at the inner ring orifice and fixed with the surrounding transverse fascia. After reconstructing the inner and outer rings, the small fingertips of the patients who needed to be accommodated were passed smoothly to ensure the tension-free passage of spermatic cord and other structures. Investigation: Testicular temperature, testicular volume, internal diameter of spermatic vein, maximum flow velocity of spermatic artery, resistance coefficient of spermatic artery and serum testosterone concentration of the affected side and the healthy side.3 Results: Statistical analysis was made by SPSS 19.0 statistical software according to the collected experimental data, P 0.05 was statistically significant. The unilateral primary inguinal hernia patients underwent Millikan herniorrhaphy were followed up for up to 6 months. One month after operation, 3 patients were lost to follow-up, and 6 patients were lost to follow-up 6 months after operation. The average size of the hernia ring defect was 2.5 (+ 0.8 cm). The operation was successful and there were no complications during the operation. The temperature, testicular volume, internal diameter of spermatic vein, maximal blood flow of spermatic cord artery, resistance coefficient of spermatic cord artery were measured by paired t test before operation, 1 month after operation and 6 months after operation. One-way ANOVA was performed before operation, one month after operation, and six months after operation. The results showed that P values were all (> 0.05), and there was no significant difference between the two groups. Paired t test was performed on the affected side (10.9 (+ 2.0 cm 3), the normal side (2.0 (+ 0.3 mm) of the internal diameter of spermatic vein (2.0 (+ 0.3 mm)) vs (2.0 (+ 0.3 mm)), the normal side (13.2 (+ 2.7 cm / s) vs. the affected side (13.6 (+ 2.7 cm / s)), and the normal side (0.76 (+ 0.06) vs. the affected side (0.77 (+ 0.07)) of the spermatic vein (P > 0.05). Contrast: the healthy side of testis temperature (36.1 ((36.1 ((36.1 (((36.1 ((36.1 ((36.1 ((36.1 (0.4 () vs (36.1 () vs vs vs (36.1 (() 0.4 (), the healthy side of testtestis volume (10.5 (2.2.3 cm / 3) vs (10.7 (2.0 (2.0 cm 3) 3) 3) vs (10.7 (2.0 cm 3), the healthy side of sperveinternal diameter of sperve (2.0 ((2.0 () 0 (), 2.0 afflicted There was no significant difference between the healthy side and the affected side at 6 months after operation. The temperature of testis was 36.0.3, the volume of testis was 10.6 Matched t-test was performed on the uninjured side (12.7 +2.6 cm/s) vs (13.3 +2.0 cm/s), the uninjured side (0.75 +0.06) vs (0.77 +0.05). There was no significant difference between the preoperative, postoperative and postoperative parameters of the uninjured side (P > 0.05). 1 month (36.1 [(36.1 [(36.1 [(36.1 [0.4] vs 6 months (36.0 [(36.0 [0.3 [0.3] vs 6 months (36.0 [(36.1 [0.1] 0.4] vs 6 months (36.0 [(36.0] 0.0.4] vs 6 months after surgery), 6 months (10.8 [(10.8 [2.2.2.2 cm3] vs 1 month (11.0 [(11.0 [2.2.2.2.2.2 cm3) vs 1 month (11.0 [(11.0 [(10.0 [2.2.2.2.2(13.3 +2.1 cm/s) vs 6. The mean value of one-way ANOVA (one-way ANOVA) was 4.01 (+ 1.06ng/ml) vs. 1 month (13.3 (+ 2.0cm/s), 6 months (0.76 (+ 0.07) vs. 1 month (0.76 (+ 0.05)) after operation, and 1 month (3.93 (+ 1.06ng/ml) vs. 6 months (4.01 (+ 1.03ng/ml) after operation. Conclusion: Millikan herniorrhaphy has no significant effect on testicular blood perfusion and testosterone concentration in the short term, but the long-term effect needs further observation.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R656.2

【共引文獻(xiàn)】

相關(guān)博士學(xué)位論文 前5條

1 楊文軍;核因子-κB在70%門(mén)靜脈分支高位結(jié)扎后大鼠肝臟增殖與凋亡中的作用研究[D];重慶醫(yī)科大學(xué);2003年

2 林科燦;肝臟三維重建及虛擬肝臟手術(shù)規(guī)劃臨床應(yīng)用的研究[D];福建醫(yī)科大學(xué);2008年

3 馬龍洋;1、NEDD9在肝癌侵襲轉(zhuǎn)移中的作用研究 2、肝癌單鏈抗體的可溶性表達(dá)及活性鑒定[D];第四軍醫(yī)大學(xué);2009年

4 李建軍;腹腔鏡技術(shù)在高位膽道外科中的應(yīng)用研究[D];廣西醫(yī)科大學(xué);2013年

5 崔偉;磷脂爬行酶1在結(jié)直腸癌組織中的表達(dá)及其生物學(xué)功能的研究[D];第三軍醫(yī)大學(xué);2013年

，

本文編號(hào)：2229670