Factors Influencing Vascularization After Childhood Ingui Nal Hernia Surgery

ObJective:The clinical data of children with postoperative obfuscating anospermia due to inguinal hernia were collected from the Department of Men’s Affairs of the First Affiliated Hospital of Zhengzhou University,including preoperative basic information,medical history,relevant examinations,intraoperative exploration,microscopic findings,postoperative semen analysis and other follow-up.Based on this,the surgical effect of vasectomy under the microscope for such patients and the related factors affecting the surgical effect were discussed.Through the analysis and discussion of the results,the clinical treatment could be better guided and the basis could be provided for further improving the effect of vasectomy under the microscope for such patients.Methods:Collect male first affiliated hospital of zhengzhou university in July 2015 to June 2020 were obstructed without a history of childhood inguinal hernia surgery patients,according to strict inclusion and exclusion criteria,were selected in accordance with the study object,a total of 65 cases of complete microscopic vas deferens anastomosis surgery and postoperative with 60 cases for visitors.According to the age,body mass index,hernia time,surgical side,intraoperative microscopic examination of sperm were divided into the corresponding study group.The overall age of the patients was(25.61±2.05)years old,the body mass index was(25.02±2.53)kg/m2,and the history of inguinal hernia surgery was(19.05±2.37)years.According to the intraoperative conditions,57 patients underwent bilateral inguinal hernia surgery.During the operation,48 patients underwent bilateral anastomosis and 9 underwent unilateral anastomosis(2 patients had abnormal development of one side of the vas deferens,5 patients had long defect segment,and 2 patients had distal obstruction).3 patients were treated after unilateral inguinal hernia repair due to infertility of contralateral testis after resection of cryptorchidism or testicular tumor.The full epididymis and thickened vas deferens could be palpated in all patients.No sperm was detected in preoperative semen analysis,the presence of alpha neutral serotonin in seminal plasma biochemistry was lower than the lower limit of normal value,and fructose was in the normal value.Routine scrotal ultrasonography showed enlargement of epididymis and vasodilation.After the relevant preoperative examinations and tests were completed,the contraindications to surgery were excluded,and the surgical exploration or anastomosis was conducted with the assistance of surgical microscope.After the operation,a special person was arranged to make timely statistics and collation of the patients’ intraoperative observations,preoperative semen routine,seminal plasma biochemical examinations and other auxiliary examinations,as well as the basic information of the patients.At the same time,the semen analysis of the patients at 1,3,6 and 12 months outside the hospital was followed up,as well as the possible postoperative complications such as wound infection and scrotal edema.According to the collected information,the corresponding statistical software is used for statistical analysis.Results:In the end,62 cases in this group completed the operation successfully,among which 60 cases were followed up and 2 cases were lost to follow-up,the follow-up rate was 96.77%(60/62),and the follow-up time was(13.37±3.63)months.Postoperatively,44 cases were recanalization,and the recanalization rate was 73.33%(44/60).During the follow-up,no obstruction was found after recanalization.When the chi-square test was used for univariate analysis,age,body mass index and postoperative time of hernia all met the normal distribution.The cut-off values were 26 years old,25.02kg/m2,and 19 years.The relapse rates of patients aged<26 years and≥26 years were 78.13%(25/32)and 67.86%(19/28,P=0.370),respectively.The relapse rates of patients with BMI<25.02kg/m2 and≥25.02kg/m2 were 73.07%(19/26)and 71.43%(25/34,P=0.969),respectively.The recanalization rates of patients with hernia less than 19 years and≥19 years were 78.26%(18/23)and 70.27%(26/37,P=0.704),respectively.The recurrence rate of spermatozoa group and spermatozoa group were 62.5%(20/32)and 85.71%(24/28,P=0.083)respectively.According to the conditions of intraoperative investigation,the postoperative recurrence rates of the patients with final unilateral anastomosis and bilateral anastomosis were 41.67%(5/12)and 81.25%(39/48,P=0.016),respectively.Multivariate logistic regression showed that the surgical side was closely related to postoperative recurrence(P=0.027),and the differences were statistically significant.Conclusion:1.Vascular anastomosis under the microscope can lead to a higher overall postoperative recanalization rate for children with obstructive asthenospermia after inguinal hernia surgery,and surgical treatment can be a priority choice for such patients.2.As far as the subJects of this study are concerned,the operative side is the influencing factor of postoperative recanalization.