不同类型疝网片与大鼠精索粘连情况及其对精子活力和睾丸HIF-1α的影响

目的：通过大鼠实验动物模型，对比研究聚丙烯网片、膨体聚四氟乙烯网片在开放性无张力疝修补术后与精索的粘连情况及其对精子活力和睾丸HIF-1α的影响。方法将32只成年雄性大鼠，随机分成4组，每组8只，分别给予正常对照、假手术、聚丙烯网片和膨体聚四氟乙烯网片开放性无张力疝修补术。术后90 d观察大鼠腹股沟区粘连程度；免疫组化法测睾丸低氧诱导因子（HIF-1α）；取附睾内精液检测大鼠精子活率。结果各组术后一般情况良好。膨体聚四氟乙烯组疝网片与精索无粘连或轻度粘连，聚丙烯网片组疝网片与精索粘连较严重；聚丙烯网片组HIF-1α表达强度（85.8±20.9）×10-3]显著升高，与正常组（2.3±0.6）×10-3]比较，差异有统计学意义；膨体聚四氟乙烯组HIF-1α表达强度（4.2±2.7）×10-3]与假手术组（2.6±0.7）×10-3]、正常组比较，差异无统计学意义。假手术组（69.83％±8.83％）、膨体聚四氟乙烯组精子活率（63.90％±6.23％）与正常组（80.32％±4.33％）比较，差异无统计学意义；聚丙烯网片组精子活率（37.25％±11.54％）降低，与正常组、假手术组比较，差异有统计学意义。结论不同材料疝网片对雄性大鼠的生殖功能影响不同，重型聚丙烯网片影响较大，膨体聚四氟乙烯网片影响较小。建议年轻患者应用传统的Shouldice法进行修补，必须行无张力修补术者应使用膨体聚四氟乙烯网片。

Effects of different hernia meshes on the adhesion degree with spermatic cord and sperm viability and testicular HIF-1αexpression

Objective To compare the effects of polypropylene mesh （PP）and expanded polytetrafluoroethylene mesh （e-PTFE）meshe on the adhesion with spermatic cord and sperm viability and testicular HIF-1αexpression in the open tension-free hernioplasty in rats. Methods Thirty-two male SD rats were randomly divided into 4 groups：the normal control group （NC）,the sham operation group （SO）,the PP）and the e-PTFE group.At day 90,we observed postoperative general situation and degree of adhesion of spermatic cord around the meshes in each group;we took testicular tissue of operative side to measure the HIF-1αexpression by IHC,and we measured sperm viability by sperm counting. Results General situations in 4 groups were all well.No or mild adhesion was observed in the e-PTFE group,but severe adhesion between the hernia mesh and the spermatic cord in the PP group.The expression of HIF-1αwas significantly elevated in the PP group （85.8 ±20.9）×10 -3 ]compared with the NC group （2.3 ±0.6）×10 -3 ].Expression of HIF-1αin the e-PTFE group （4.2 ±2.7）×10 -3 ]was neither different from the NC nor the SO group （2.6 ±0.7）× 10 -3 ].There were not statistical significances in sperm viability between the NC （80.32%±4.33%）,SO （69.83%± 8.83%）and e-PTFE group （63.90% ±6.23%）.The sperm viability of the PP group （37.25% ±11.54%）was significantly lower compared with the SO or e-PTFE group. Conclusion Effects on the reproductive function of male rats were observed when applying tension-free hernioplasty with hernia meshes.The effects varied by types of meshes,with PP the greatest while e-PTFE the slightest.It is recommend to employ Shouldice instead of tension-free hernioplasty with hernia meshes;nevertheless the application of e-PTFE mesh is acceptable when the surgery is obligatory.