腹腔镜下精索血管高位离断后大鼠睾丸的形态学改变

目的观察腹腔镜FowlerStephens(FS)手术对青春发育前、中、后期睾丸形态结构的影响。方法30d龄Wistar大鼠麻醉后建立CO2气腹,分别行右侧精索血管游离术(对照组)、右侧腹腔内精索血管离断术(FS组),术后将每大组大鼠再分成7个小组(对照组每小组5只;FS组每小组8～12只),分别在术后第9d(青春发育期前)、20d和45d(青春发育期)、90d和180d(性发育成熟期)、360d和540d(中年期),获取睾丸进行详尽的组织形态学研究。结果FS手术可以引起术后不同时期共85%手术侧睾丸出现轻度(血睾屏障受损为主)、重度(唯支持细胞综合征为主)和完全萎缩(丧失睾丸基本结构,无生殖细胞存活);当轻度或重度萎缩,对侧睾丸未受累;当完全萎缩(49%),对侧睾丸在手术45d后,100%出现轻度(青春发育期后)或重度(中年期)萎缩;间质细胞增生或腺瘤可发生于轻、重和完全萎缩睾丸中(P<0.001)。结论腹腔镜FS动物模型可用幼年大鼠建立;该手术可以引起从青春发育前期至中年期较高比例、不同程度的睾丸萎缩,其中完全萎缩可以影响到对(健)侧睾丸,而可能引起青春发育期后生殖力下降或丧失;睾丸间质肿瘤可以较高比例地发生于不同程度萎缩睾丸中。

Morphological alterations of rat testes after intraabdominal dissection of spermatic cord vessels

Objective To simulate a laparoscopic F S procedure in young rats and evaluated the morphologic alterations in detail with regard to testicular atrophy.Methods Thirty day old Wistar rats divided into 2 groups underwent laparoscopic sham operation and unilateral laparoscopic F S procedure.Detailed morphological investigations were performed at 7 different postoperative intervals between the 9th day and 18th month.Results Laparoscopic F S procedure induced testicular atrophy in 85% of the operated testes with different degrees of spermatogenic arrest. Mild(blood testis barrier damaged), severe (Sertoli cell only syndrome) and complete (normal testicular structure collapsed) testicular atrophy were used to define atrophy according to the morphologic alterations observed. In mild or severe atrophy, the testicular size of the operated testis was only slightly reduced compared to the age matched controls, whereas the contra lateral testis was not involved. In complete atrophy (49% of the operated testes) a striking size reduction with necrosis of the testicular parenchyma and marked central microlithiasis was observed. The contra lateral testes revealed in all cases mild or severe atrophy beginning as early as the 45th day postoperatively and eventually developed severe atrophy 18 months later. Parallel to the testicular atrophy, Leydig cell (LC) hyperplasia developed in mild or severe atrophic testes and finally reached a typical adenoma size in the operated and the contra lateral atrophic testes. In the complete atrophic testes, LC hyperplasia also developed.Conclusions An animal model for laparoscopic F S procedure could be established in prepubertal Wistar rats. This laparoscopic F S procedure induced a high incidence of testicular atrophy in various severities, which could result in sub or infertility due to impaired spermatogenesis, as well as LC hyperplasia or adenoma formation in the atrophic testes.