Millikan疝修补手术对患者睾丸血流灌注及血清睾酮浓度的影响
发布时间：2018-09-08 06:38
【摘要】：目的:探索Millikan疝修补手术对患者睾丸血流灌注及血清睾酮浓度的影响,对临床上腹股沟疝患者采用无张力疝修补术式提供参考。资料:2013年10月至2014年4月,河北医科大学第二医院疝与腹壁外科收治并行Millikan疝修补手术的腹股沟疝男性患者35例,年龄为65±9岁,均为原发性单侧腹股沟疝,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,并签署知情同意书。方法:1手术方法:所有患者均择期于局麻下行Millikan疝修补手术,补片均采用意大利Herniamesh有限公司生产的赫美补片(聚丙烯网塞+平片),局麻药采用利多卡因与罗哌卡因的混合液。找到疝囊,完整剥离疝囊至内环口,切开其内侧腹横筋膜并充分游离周围腹膜前间隙。然后将帽状网塞填充于内环口处腹膜前间隙,并与周围腹横筋膜固定3-4针,再将平片平铺于精索后方的腹股沟管后壁,并与周围组织缝合固定。将内、外环重建后,需均可容术者小指尖顺利通过,来确保精索等结构无张力通过。缝合线均采用3-0可吸收线。2研究时间及内容:术前、术后1个月、术后6个月分别检查:患侧与健侧的睾丸温度、睾丸体积、精索静脉内径、精索动脉最大血流速、精索动脉阻力系数及外周血清睾酮浓度。3结果处理及统计分析:应用SPSS 19.0统计学软件根据采集的实验数据进行统计学分析,P0.05为有统计学意义。结果:对35例进行了Millikan疝修补手术的单侧原发性腹股沟疝患者,进行了长达6个月的随访。术后1个月时,有3例失访,术后6个月时,有6例失访。疝环缺损大小平均2.5±0.8cm。手术顺利,术中均无并发症。对资料收集、整理后,利用SPSS 19.0处理,所有资料均符合正态分布,并且相关系数检验P值0.05。于术前、术后1个月、术后6个月三个时间点,分别将健侧与患侧的睾丸温度、睾丸体积、精索静脉内径、精索动脉最大血流、精索动脉阻力系数行配对t检验。将患侧睾丸温度、体积、血流灌注及外周血睾酮浓度,分别于术前、术后1个月、术后6个月三个时间点间行均数的方差分析(one-way ANOVA),发现P值均≥0.05,均无统计学意义。具体如下:1术前健侧与患侧各指标的对比情况:睾丸温度健侧(36.1±0.4℃)vs患侧(36.1±0.5℃)、睾丸体积健侧(10.8±2.1cm3)vs患侧(10.9±2.0cm3)、精索静脉内径健侧(2.0±0.3mm)vs(2.0±0.3mm)、精索动脉最大血流健侧(13.2±2.7cm/s)vs患侧(13.6±2.7cm/s)、精索动脉阻力系数健侧(0.76±0.06)vs患侧(0.77±0.07),均行配对t检验,P值均≥0.05,无统计学意义。2术后1个月健侧与患侧各指标的对比情况:睾丸温度健侧(36.1±0.4℃)vs患侧(36.1±0.4℃)、睾丸体积健侧(10.5±2.3cm3)vs患侧(10.7±2.0cm3)、精索静脉内径健侧(2.0±0.4mm)vs患侧(2.0±0.3mm)、精索动脉最大血流健侧(13.0±2.2cm/s)vs患侧(13.3±2.0cm/s)、精索动脉阻力系数健侧(0.76±0.06)vs患侧(0.77±0.06),均行配对t检验,P值均≥0.05,无统计学意义。3术后6个月健侧与患侧各指标的对比情况:睾丸温度健侧(36.0±0.3℃)vs患侧(36.0±0.3℃)、睾丸体积健侧(10.6±1.9cm3)vs患侧(10.8±2.0cm3)、精索静脉内径健侧(2.0±0.3mm)vs(2.0±0.3mm)、精索动脉最大血流健侧(12.7±2.6cm/s)vs患侧(13.3±2.0cm/s)、精索动脉阻力系数健侧(0.75±0.06)vs患侧(0.77±0.05),均行配对t检验,P值均≥0.05,无统计学意义。4患侧各指标于术前、术后1个月、术后6个月三个时间点间的对比情况:睾丸温度术前(36.1±0.5℃)vs术后1月(36.1±0.4℃)vs术后6月(36.0±0.3℃)、睾丸体积术前(11.0±2.2cm3)vs术后1月(10.8±2.0cm3)vs术后6月(10.8±2.0cm3)、精索静脉管径术前(2.0±0.3mm)vs术后1月(2.0±0.3mm)vs术后6月(2.0±0.3mm)、精索动脉最大流速术前(13.5±3.0cm/s)vs术后1月(13.3±2.1cm/s)vs术后6月(13.3±2.0cm/s)、患侧精索动脉阻力系数术前(0.77±0.08)vs术后1月(0.76±0.07)vs术后6月(0.77±0.05)、睾酮浓度术前(4.01±1.17ng/ml)vs术后1月(3.93±1.06ng/ml)vs术后6月(4.01±1.03ng/ml),均行均数的方差分析(one-way ANOVA),组间P值均≥0.05,均无统计学意义。结论:Millikan疝修补手术在短期内对患者睾丸血流灌注及睾酮浓度没有明显影响,但长期影响,尚需进一步的观察。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.2
本文编号：2229670
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.2
【共引文献】
相关博士学位论文 前5条
1 杨文军;核因子-κB在70%门静脉分支高位结扎后大鼠肝脏增殖与凋亡中的作用研究[D];重庆医科大学;2003年
2 林科灿;肝脏三维重建及虚拟肝脏手术规划临床应用的研究[D];福建医科大学;2008年
3 马龙洋;1、NEDD9在肝癌侵袭转移中的作用研究 2、肝癌单链抗体的可溶性表达及活性鉴定[D];第四军医大学;2009年
4 李建军;腹腔镜技术在高位胆道外科中的应用研究[D];广西医科大学;2013年
5 崔伟;磷脂爬行酶1在结直肠癌组织中的表达及其生物学功能的研究[D];第三军医大学;2013年
，本文编号：2229670
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2229670.html
最近更新
教材专著
