Peiper Christian, Junge Karsten, Klinge Uwe, Strehlau Eva, Krones Carsten, Ottinger A, Schumpelick Volker
Surgical Clinic, Evangelisches Krankenhaus, Witten, Germany.
J Invest Surg. 2005 Sep-Oct;18(5):273-8. doi: 10.1080/08941930500249027.
The permanent implantation of a polypropylene mesh during inguinal hernia repair causes chronic inflammatory changes in the surrounding tissue. We investigated the effect of this foreign body reaction on the structures of the spermatic cord in the rabbit. Eight Chinchilla rabbits underwent unilateral inguinal hernia repair by the Lichtenstein technique using Marlex (n = 4) or Ultrapro (n = 4) mesh. The contralateral side was operated upon using the Shouldice repair. Three animals served as controls. Three months after operation we analyzed testicular size, testicular temperature, and arterial perfusion by excitation light of a 780-nm laser after injection of 0.5 mg/kg indocyanin green. Histological evaluation included spermatogenesis (Johnsen score) and foreign-body reaction. Testicular volume increased about 10% after each operation. The decrease of arterial perfusion and testicular temperature was more significant after mesh repair than following Shouldice operation. After mesh implantation we found fewer seminiferous tubules classified as Johnsen 10 (Marlex: 51.3%, Ultrapro: 45.0%) than after Shouldice repair (63.8%) or in the controls (65.8%). The spermatic cord showed a typical foreign-body reaction at the interface between mesh and surrounding tissue, which was not detectable after Shouldice repair. Preserved cremasteric muscle fibers protected the structures of the spermatic cord. The inflammatory foreign-body reaction of the surrounding tissue induced by the inguinal prosthetic mesh includes the structures of the spermatic cord. This may have an influence also on spermatogenesis. Therefore, we recommend strict indications for implantation of a prosthetic mesh during inguinal hernia repair.
腹股沟疝修补术中聚丙烯网片的永久性植入会导致周围组织发生慢性炎症变化。我们研究了这种异物反应对兔精索结构的影响。八只青紫蓝兔采用利氏技术，使用 Marlex（n = 4）或 Ultrapro（n = 4）网片进行单侧腹股沟疝修补。对侧采用 Shouldice 修补术。三只动物作为对照。术后三个月，我们通过注射 0.5 mg/kg 吲哚菁绿后用 780 纳米激光激发光分析睾丸大小、睾丸温度和动脉灌注。组织学评估包括精子发生（约翰森评分）和异物反应。每次手术后睾丸体积增加约 10%。网片修补后动脉灌注和睾丸温度的下降比 Shouldice 手术后更显著。网片植入后，我们发现分类为约翰森 10 级的生精小管比 Shouldice 修补术后（63.8%）或对照组（65.8%）少（Marlex：51.3%，Ultrapro：45.0%）。精索在网片与周围组织的界面处表现出典型的异物反应，而在 Shouldice 修补术后未检测到这种反应。保留的提睾肌纤维保护了精索结构。腹股沟假体网片诱导的周围组织炎症异物反应累及精索结构。这也可能对精子发生产生影响。因此，我们建议在腹股沟疝修补术中严格掌握假体网片植入的适应证。
