焦点｜补片与男性生殖

自外科理念的更新，临床上腹股沟疝大规模使用的材料修补已近30多年，人工合成的不吸收网片是否会影响男性的生殖功能？一直是一个吸引眼球的话题。如果遇到一个未婚的男性腹股沟病人，如何修补？肯定会有人说：不用补片，缝合修补。为什么？是补片影响男性的生殖，还是手术做的不好？今天小编，就此话题，再次去Pumbmed去搜索。以关键词，男性生殖与腹股沟疝（Male infertility and ingunal hernia），共计有28篇文献，没有一篇文章说材料对男性的生殖功能造成影响，这里小编就一些有意义的文章与各位分享。

Does the use of hernia mesh in surgical inguinal hernia repairs cause male infertility? A systematic review and descriptive analysis

在腹股沟疝修补术中使用网片会引起男性不育吗？

——系统回顾和描述性分析

作者：Zhiyong Dong,等

杂志：Reprod Health. 2018; 15: 69.

Objective

The aim of this study was to systematically review the available clinical trials examining male infertility after inguinal hernias were repaired using mesh procedures.

Methods

The Cochrane Library, PubMed, Embase, Web of Science, and Chinese Biomedical Medicine Database were investigated. The Jada score was used to evaluate the quality of the studies, “Oxford Centre for Evidence-based Medicine-Levels of Evidence” was used to assess the level of the trials, and descriptive analysis was used to evaluate the studies.

Results

Twenty nine related trials with a total of 36,552 patients were investigated, including seven randomized controlled trials (RCTs) with 616 patients and 10 clinical trials (1230 patients) with mesh or non-mesh repairs. The Jada score showed that there were six high quality RCTs and one low quality RCT. Levels of evidence determined from the Oxford Centre for Evidence-based Medicine further demonstrated that those six high quality RCTs also had high levels of evidence. It was found that serum testosterone, LH, and FSH levels declined in the laparoscopic group compared to the open group; however, the testicular volume only slightly increased without statistical significance. Testicular and sexual functions remained unchanged after both laparoscopic transabdominal preperitoneal hernia repair (TAPP) and totally extra-peritoneal repair (TEP). We also compared the different meshes used post-surgeries. VyproII/Timesh lightweight mesh had a diminished effect on sperm motility compared to Marlex heavyweight mesh after a one-year follow-up, but there was no effect after 3 years. Additionally, various open hernia repair procedures (Lichtenstein, mesh plug method, posterior pre-peritoneal mesh repair, and anterior tension-free repair) did not cause infertility.

Conclusions

This systematic review suggests that hernia repair with mesh either in an open or a laparoscopic procedure has no significant effect on male fertility.

该研究共对29项相关报告进行了研究，共计36552例患者，其中包括7项随机对照临床试验（RCT）616例患者和10项进行网片或未用网片修复的临床试验（1230例）。

结论：通过本系统回顾分析表明，无论在开放式或腹腔镜手术中使用网片修补术对男性生育力没有显著性着影响。.

该文所分析的主要文章如下表

另一篇研究

题目：Male infertility after mesh hernia repair: A prospective study

使用网片疝修补术后男性不育的一项前瞻性研究

作者：Magnus Hallén等

杂志：Surgery 2011 Feb;149(2):179-84.

Abstract

Background: Several animal studies have raised concern about the risk for obstructive azoospermia owing to vasal fibrosis caused by the use of alloplastic mesh prosthesis in inguinal hernia repair. The aim of this study was to determine the prevalence of male infertility after bilateral mesh repair.

Methods: In a prospective study, a questionnaire inquiring about involuntary childlessness, investigation for infertility and number of children was sent by mail to a group of 376 men aged 18-55 years, who had undergone bilateral mesh repair, identified in the Swedish Hernia Register (SHR). Questionnaires were also sent to 2 control groups, 1 consisting of 186 men from the SHR who had undergone bilateral repair without mesh, and 1 consisting of 383 men identified in the general population. The control group from the SHR was matched 2:1 for age and years elapsed since operation. The control group from the general population was matched 1:1 for age and marital status.

Results: The overall response rate was 525 of 945 (56%). Method of approach (anterior or posterior), type of mesh, and testicular status at the time of the repair had no significant impact on the answers to the questions. Nor did subgroup analysis of the men ≤40 years old reveal any significant differences.

Conclusion: The results of this prospective study in men do not support the hypothesis that bilateral inguinal hernia repair with alloplastic mesh prosthesis causes male infertility at a significantly greater rate than those operated without mesh.

（译文）

研究背景：

有动物的研究引起了人们的关注，因为使用了人工合成的网状假体补片进行修复腹股沟疝可能会导致血管纤维化，从而导致（输精管）阻塞性无精子症的风险。本研究的目的是确定在双侧使用了网状补片修补腹股沟疝以后男性不育的患病率。

方法：

在一项前瞻性研究中，将询问非自愿性无子女，不育症和儿童人数的调查表邮寄给了一组在瑞典疝气登记册中确定的376名年龄在18-55岁的人，他们进行了双侧网状修复。（Swedish Hernia Registe 瑞典疝病登记库SHR）。还向两个对照组发送了问卷，其中1个是SHR的186名男性，他们接受了网片的双侧腹股沟疝修补，另外1个是在普通人群中确定的383名男性。 

瑞典疝病登记库中（SHR）的对照组在手术后的年龄和年龄上匹配为2：1。普通人群的对照组的年龄和婚姻状况为1：1。

结果：

总体该研究的回应率为945的525（56％）。手术方法（前入路或后入路），网状片和修补时的睾丸状态对问题的答案没有显着影响。≤40岁男性的亚组分析也未发现任何显着差异。

结论：该项研究针对男性的前瞻性研究结果不支持以下假设：使用异体的网状补片修复双侧腹股沟疝导致男性不育的发生率明显高于不使用补片手术。

第三篇研究

Incarcerated Inguinal Hernia Mesh Repair: Effect on Testicular Blood Flow and Sperm Autoimmunity.

嵌顿性腹股沟疝补片修复：对睾丸血流量和精子自身免疫的影响

Med Sci Monit. 2016 May 5;22:1524-33.

先看一篇最近的文献，

（关于嵌顿疝病人用补片修补术后的研究，察观了术后5天、和5个月后的睾丸血流和血液中的抗精子抗体等指标）

Krnić D1, Družijanić N1, Štula I2, Čapkun V3, Krnić D4.

Abstract

BACKGROUND The aim of our study was to determine an influence of incarcerated inguinal hernia mesh repair on testicular circulation and to investigate consequent sperm autoimmunity as a possible reason for infertility. 

MATERIAL AND METHODS This prospective study was performed over a 3-year period, and 50 male patients were included; 25 of these patients underwent elective open meshhernia repair (Group I). Group II consisted of 25 patients who had surgery for incarcerated inguinal hernia. Doppler ultrasound evaluation of the testicular blood flow and blood samplings for antisperm antibodies (ASA) was performed in all patients before the surgery, on the second day, and 5 months after. Main outcome ultrasound measures were resistive index (RI) and pulsative index (PI), as their values are inversely proportional to testicular blood flow. 

RESULTS In Group I, RI, and PI temporarily increased after surgery and then returned to basal values in the late postoperative period. Friedman analysis showed a significant difference in RI and PI for all measurements in Group II (p<0.05), with a significant decrease between the preoperative, early, and late postoperative periods. All final values were within reference range, including ASA, despite significant increase of ASA in the late postoperative period. CONCLUSIONS Although statistically significant differences in values of testicular flow parameters and immunologic sensitization in observed time, final values remained within the reference ranges in all patients. Our results suggest that the polypropylene mesh probably does not cause any clinically significant effect on testicular flow and immunologic response in both groups of patients. 

结论：聚丙烯补片是安全的，未发现对男性的睾丸血流和免疫方面有任何问题。

最后，小编要说：如果说真的有材料对人生殖功能造成影响FDA一定不会饶过的计设者和开发商。