| Objective:Explore testicular perfusion and the concentration of serum testosterone after Millikan hernia repair operation in order to provide some clinical reference for patients with inguinal hernia.Methods:From October 2013 to April 2014, 35 patients with primary inguinal hernia(mean age 65±9 years) were operated by Millikan hernia repair method at the second hospital of Hebei medical university, including 29 cases(83%) indirect inguinal hernias, 6 cases(17%) direct inguinal hernias. The patients were informed that research objective and also signed a consent form.1 Operation method: Millikan hernia repair operation with Herniamesh patch(plug and patch) was performed under local anesthesia using Lidocaine and Ropivacaine Hydrochloride Injection. First of all, it should be found the hernial sac, peeled to the internal ring, and incisioned the abdominal transverse fascia at the inside of the internal ring, and freed the preperitoneal space around the internal ring fully. And then, a polypropylene mesh plug was implanted the preperitoneal space behind the internal ring and was sutured with the surrounding transverse fascia. And then, an additional polypropylene onlay patch was tiled on the inguinal region rear under the spermatic cord. Finally, after internal and external ring rebuilding, they should have a round aperture and be still passable for the tip of the surgeon’s small finger to insure the cord structures to pass through without tension or constriction. Sutures are used 3-0 absorbable suture.2 Research contents: Separate routine examinations on preoperative 1 month, postoperative 1 month, and postoperative 6 months include: testicular temperature, testicular volume, spermatic vein diameter, the blood flow of the spermatic artery, spermatic artery resistance coefficient on both the operated and nonoperated side and the peripheral serum testosterone concentration.3 Statistical analysis: The experimental data was analyzed by the SPSS 19.0 software, P<0.05 was considered significant.Results: Total 35 patients with the primary inguinal hernia had been operated on Millikan hernia repair and were followed up for 6 months. The mean size of hernia defect was 2.5±0.8cm. 3 cases were lost to follow-up after operation one month, and 6 cases lost contact after operation six months. No intraoperative complications occurred. After all data was collected, we found that they fitted the normal distribution by SPSS 19.0 process and were closely interrelated by test of correlation coefficient between the two. Before operation, at postoperative 1 month, at 6 months after surgery respectively, temperature of testis, testicular volume, spermatic vein diameter, spermatic artery maximum blood flow, spermatic artery resistance coefficient between the side of hernia and the contralateral side was applied comparative t-test to perform statistical analysis. Temperature of testis, testicular volume, spermatic vein diameter, spermatic artery maximum blood flow, spermatic artery resistance coefficient at the side of hernia and peripheral blood testosterone concentration between the preoperative, postoperative 1 month and 6 months postoperatively was applied the mean variance analysis(one-way ANOVA) to perform statistical analysis. We found that all P values were greater than or equal to 0.05, there was nostatistical significance. The details are as follows.1 Compared between the operated side and uninjured side before operation: testicular temperature at the contralateral side(36.1±0.4℃) vs the one at the side of hernia(36.1±0.5℃), testicular volume at the side of hernia(10.8±2.1cm3) vs the one at the side of hernia(10.9±2.0cm3), spermatic vein diameter at the contralateral side(2±0.3mm) vs the one at the side of hernia(2±0.3mm), the maximum blood flow of spermatic artery at the contralateral side(13.2±2.7cm/s) vs the one at the side of hernia(13.6±2.7cm/s), spermatic artery resistance coefficient at the contralateral side(0.76±0.06) vs the one at the side of hernia(0.77±0.07), were applied comparative t-test. We found that all values of P were greater than or equal to 0.05, no statistical significance.2 Compared between the operated side and uninjured side after operation at one month: testicular temperature at the contralateral side(36.1±0.4℃) vs the one at the side of hernia(36.1±0.4℃), testicular volume at the side of hernia(10.5±2.3cm3) vs the one at the side of hernia(10.7±2.0cm3), spermatic vein diameter at the contralateral side(2.0±0.4mm) vs the one at the side of hernia(2.0±0.3mm), the maximum blood flow of spermatic artery at the contralateral side(13.0±2.2cm/s) vs the one at the side of hernia(13.3±2.0cm/s), spermatic artery resistance coefficient at the contralateral side(0.76±0.06) vs the one at the side of hernia(0.77±0.06), were applied comparative t-test. We found that all values of P were greater than or equal to 0.05, no statistical significance.3 Compared between the operated side and uninjured side after operation at six months: testicular temperature at the contralateral side(36.0±0.3℃) vs the one at the side of hernia(36.0±0.3℃), testicular volume at the side of hernia(10.6±1.9cm3) vs the one at the side of hernia(10.8±2.0cm3), spermatic vein diameter at the contralateral side(2.0±0.3mm) vs the one at the side of hernia(2.0±0.3mm), the maximum blood flow of spermatic artery at the contralateral side(12.7±2.6cm/s) vs the one at the side of hernia(13.3±2.0cm/s), spermatic artery resistance coefficient at the contralateral side(0.75±0.06) vs the one at the side of hernia(0.77±0.05), were applied comparative t-test. We found that all values of P were greater than or equal to 0.05, no statistical significance.4 Compared among pre-operation, after surgery at one month and after surgery at six months: preoperative testicular temperature(36.1±0.5℃) vs the one after surgery at one month(36.1±0.4℃) vs the one after surgery at six months(36.0±0.3℃), preoperative testicular volume(11.0±2.2cm3) vs the one after surgery at one month(10.8±2.0cm3) vs the one after surgery at six months(10.8±2.0cm3), preoperative spermatic vein diameter(2.0±0.3mm) vs the one after surgery at one month(2.0±0.3mm) vs the one after surgery at six months(2.0±0.3mm), the preoperative maximum blood flow of spermatic artery(13.5±3.0cm/s) vs the one after surgery at one month(13.3±2.1cm/s) vs the one after surgery at six months(13.3±2.0cm/s), the preoperative spermatic artery resistance coefficient(0.77±0.08) vs the one after surgery at one month(0.76±0.07) vs the one after surgery at six months(0.77±0.05), the preoperative testosterone concentration(4.01±1.17ng/ml) vs the one after surgery at one month(3.93±1.06ng/ml) vs the one after surgery at six months(4.01±1.03ng/ml), were applied the mean variance analysis(one-way ANOVA). We found that all values of P were greater than or equal to 0.05, no statistical significance.Conclusions:The testicular blood flow perfusion and testosterone concentrations had no significant effect in patients after the Millikan hernia repair operation in the short term, but the effect of long-term, still need further observation. |
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