Ramadan Selma Uysal, Gokharman Dilek, Tuncbilek Isil, Ozer Hilal, Kosar Pinar, Kacar Mahmut, Temel Selim, Kosar Ugur
Department of Radiology, Ankara Training and Research Hospital, Ulucanlar, Ankara, Turkey.
J Clin Ultrasound. 2009 Feb;37(2):78-81. doi: 10.1002/jcu.20516.
Modern treatment of inguinal hernias includes prosthetic mesh repairs. However, direct contact of the mesh to the vessels in the inguinal canal and perimesh fibrosis may have a negative impact on testicular flow. The aim of this prospective study was to evaluate the effect of mesh implantation/perimesh fibrosis on testicular flow after repair of indirect inguinal hernias (IIHs).
Forty-eight male patients with unilateral IIH were included. Both testicular parenchyma were assessed using gray-scale sonography, and color/spectral Doppler sonography was performed to evaluate testicular arterial impedance, perfusion, and venous flow. Measurements were made bilaterally at the level of the inguinal canal 1 day before and at the end of the 2nd month after the operation.
There was no difference in testicular and echotexture perfusion between the hernia and the control sides pre- and postoperatively. No venous thrombosis was found. In all groups, resistance index and pulsatility index, measured at 4 levels, were highest in the proximal inguinal canal and lowest at the extratesticular-intrascrotal level (p < 0.05). For all Doppler parameters there was no significant difference between the pre- and postoperative measurements on both the hernia and the control sides.
Mesh implantation/perimesh fibrosis does not adversely affect ipsilateral testicular flow. Mesh application is still a safe procedure in male patients in whom testicular function is important.
现代腹股沟疝治疗方法包括使用人工合成补片进行修补。然而，补片与腹股沟管内血管的直接接触以及补片周围纤维化可能会对睾丸血流产生负面影响。本前瞻性研究的目的是评估在修补腹股沟斜疝（IIH）后，补片植入/补片周围纤维化对睾丸血流的影响。
纳入48例单侧IIH男性患者。使用灰阶超声评估双侧睾丸实质，并进行彩色/频谱多普勒超声检查以评估睾丸动脉阻抗、灌注和静脉血流。在手术前1天和术后第2个月末，在腹股沟管水平双侧进行测量。
术前和术后，疝侧与对照侧的睾丸及回声质地灌注均无差异。未发现静脉血栓形成。在所有组中，在4个水平测量的阻力指数和搏动指数在腹股沟管近端最高，在睾丸外-阴囊内水平最低（p < 0.05）。对于所有多普勒参数，疝侧和对照侧术前和术后测量之间均无显著差异。
补片植入/补片周围纤维化不会对同侧睾丸血流产生不利影响。在睾丸功能重要的男性患者中，应用补片仍然是一种安全的手术方法。
