摘要目的 探讨皮片游离移植修复全阴囊皮肤撕脱伤对睾丸生精功能的影响.方法 以育龄期健康新西兰大白兔作为实验动物,雄性42只,雌性24只.将雄兔随机分为实验组(24只)及对照组(18只).将实验组动物双侧阴囊皮肤全层切除,采用腹部中厚皮片游离移植修复缺损.对照组未作处理.对照组及实验组造模后3周末、8周末时按随机数字表法各取6只动物采用温度计埋藏法测量睾丸表面温度,温度测量后取睾丸组织活检,常规HE染色.8周末将两组未采集活检的雄兔各12只分别与雌兔配对喂养半个月,观察对应母兔的生育情况.临床上对3例阴囊皮肤撕脱伤患者采用撕脱阴囊反取皮回植修复,并对其性生活情况及精液质量进行随访观察.结果 模型建立后3周末、8周末实验组的睾丸表面温度[(36.15±0.24)℃、(36.77±0.42)℃]与对照组的睾丸表面温度[(36.12±0.68)℃]接近,两组比较差异无统计学意义(P＞0.05)；对照组HE染色曲细精管内见各级生精细胞,排列有序,管腔内见较多的成熟精子；实验组模型建立后第3周末的HE染色见曲细精管内生精细胞明显减少,排列紊乱,管腔未见精子,第8周末曲细精管内生精细胞增多,排列相对规整,部分管腔可见成熟的精子；配对喂养对照组雌兔受孕率12/12,平均生崽数(6.0±1.3)只；实验组雌兔受孕率8/12,平均生崽数(4.1±3.2)只,两组受孕率比较差异无统计学意义.临床3例患者游离植皮修复之阴囊在术后1～2个月可见早期皮片挛缩征象,但1年后均出现松弛而下垂,阴囊外形较满意,修复2年后患者的精液质量均恢复至正常.结论皮片游离移植修复全阴囊皮肤缺损对睾丸的精子发生干扰较小,可保留青壮年患者生育能力.

abstractsObjective To explore the influence of Free-skin-grafted penoscrotal avulsion injuries on spermatogenesis.Methods Forty-two male New Zealand albino rabbits during child-bearing period were divided into the experimental group (n =24) and the control group (n =18) using random digits table,and 24 female rabbits with reproductive history were used for mating experiment.The experimental group animal's scrotum skin were excised,and the split skin from abdominal region was used to repair the skin defect of scrotum.The control group did not any processing.Six rabbits were randomly chosen respectively in control group and on the 3th and 8th weekend after the model was successfully established in experimental group.The testicular surface temperature was measured in the eighteen rabbits using the method of burying thermometer,then the testicular biopsy were performed for hematoxylin-eosin (HE) staining.On the 8th weekend after the model was successfully established in experimental group, matched-pair feed was performed in the other 12 rabbits respectively in experimental group and in control group.Obervation of corresponding mother rabbit fortility.Three patients of penoscrotal avulsion injuries were treated using split skin grafts,and the information of sex life and the quality of sperm were obtained by follow up.Results The testicular surface temperature was similar on the 3th and 8th weekend after the model was successfully established in experimental group [( 36.15 ± 0.24) ℃,( 36.77 ± 0.42 ) ℃]with that of the control group.Testis tissue (HE) staining showed the tier of spermatogenic cells was rule arrangement and lot of mature sperms were found in the convoluted seminiferous tubules in control group.The tier of spermatogenic cells was diminished and disposed derangement,the spermatozoa were not seen on the 3th weekend of the experiment group.The tier of spermatogenic cells was increased and some spermatozoa were seen on the 8th weekend of the experiment group.Male and female matched-pair feed showed the experimental group conception rate 8/12,and 4.1 ±3.2 rabbit babies were born averagely,while that of was 12/12 and 6.0 ±1.3 in control group (P ＞ 0.05).The skin grafts there were some contracture in early stage ( 1-2 months)when the skin grafts applied to repair the avulsing scrotum in three patients.But the skin grafts became loose with downward sagging and there were the good cosmetic result in one year,and without any contracture.The sperm quality was normal after the skin grafts applied to repair the avulsing scrotum in the late stage.Conclusions The skin grafting is little arrest the testicle spermatogenesis in the three methods (skin flap reconstruction scrotum,testicle buried,split skin grafting) that have usually been used to repair scrotum skin lose.For a young male,the best treatment for penoscrotal avulsion injuries is free skin grafting,while skin flaps are not recommended for reconstructing the scrotum.