腹腔镜下经尿道等离子电切术联合疝环充填式无张力疝修补术治疗腹股沟斜疝合并前列腺良性增生

Laparoscopic transurethral plasma resection combined with mesh plug tension-free hernioplasty in treating inguinal indirect hernia with benign prostatic hyperplasia in elderly patients

目的分析腹腔镜下经尿道等离子电切术(PKRP)同期联合疝环充填式无张力疝修补术(PMHR)治疗腹股沟斜疝(IIH)合并前列腺良性增生(BPH)老年患者的实际临床效果及安全性。方法前瞻性招募2021年6月至2022年6月于空军军医大学第二附属医院泌尿外科收治的IIH合并BPH老年患者,计算机随机数字法分为对照组(37例)与试验组(37例)。试验组执行腹腔镜下PKRP同期联合PMHR,对照组间隔1周分期执行腹腔镜下PKRP与PMHR。比较两组术中出血量和住院时间、国际前列腺症状评分(IPSS)、尿动力参数、Prince-Henry疼痛评分、术后尿潴留发生率。结果本项目共筛选79例患者,其中3例因经济等个人原因退出本研究,2例随访期间失访,共成功入组74例,其中试验组37例、对照组37例。治疗后,试验组术中出血量和住院时间均低于对照组(P<0.05)。试验组及对照组IPSS评分分别为(6.15±1.14)、(9.68±1.27),差异有统计学意义(P<0.05)。治疗后,试验组与对照组24 h Prince-Henry疼痛评分分别为(1.53±0.63)、(2.98±1.37),差异有统计学意义(P<0.05)。试验组与对照组急迫尿意时膀胱容量分别为(385.65±41.58)ml、(351.25±35.19)ml,膀胱顺应性分别为(43.85±7.12)ml/cmH_(2)O、(32.58±5.28)ml/cmH_(2)O,治疗后两组患者急迫尿意时膀胱容量、膀胱顺应性均升高(P<0.05),且试验组急迫尿意时膀胱容量、膀胱顺应性显著高于对照组(P<0.05)。试验组与对照组尿潴留发生率分别为8.44%(3/37)、35.14%(13/37),差异有统计学意义(校正χ^(2)=7.974,P=0.005)。结论腹腔镜下PKRP同期联合PMHR对于IIH合并BPH老年患者能够促进恢复,缓解疼痛,同时能够改善尿动力学,降低尿潴留发生率。

Objective To analyze the actual clinical results and safety evaluation of laparoscopic plasma kinetic resection of prostate(PKRP)combined with laparoscopic mesh-plug tension-free hernia hernioplasty(PMHR)for the treatment of inguinal hernia(IIH)combined with benign prostatic hyperplasia(BPH)in elderly patients.Methods From June 2021 to June 2022,a prospective recruitment was conducted at the Department of Urology,the Second Affiliated Hospital of the Air Force Medical University for elderly patients with IIH combined with BPH.Using computerized random number generation,patients were divided into two groups:a control group(37 patients)and an experimental group(37 patients).In the experimental group,patients underwent laparoscopic prostate resection with PKRP combined with PMHR in a single session.In contrast,the control group underwent these procedures in two separate sessions,with a one-week gap in between-first laparoscopic PKRP and then PMHR a week later.The study compared both groups in terms of intraoperative blood loss,length of hospital stay,International Prostate Symptom Score(IPSS),urodynamic parameters,Prince-Henry pain scores,and the incidence of post-operative urinary retention.Results A total of 79 patients were initially selected for this study.Of these,3 patients withdrew due to personal financial reasons,and 2 were lost to follow-up.Thus,a total of 74 patients were successfully enrolled,with 37 in the experimental group and 37 in the control group.Post-treatment,the experimental group had both lower surgical blood loss and a shorter hospital stay compared to the control group(P<0.05).The International Prostate Symptom Score(IPSS)for the experimental group was(6.15±1.14),while the control group scored(9.68±1.27),with the difference between the two groups being statistically significant(P<0.05).Post-operatively,the 24-hour Prince-Henry pain scores for the experimental and control groups were(1.53±0.63)and(2.98±1.37),respectively,with the difference being statistically significant(P<0.05).Regarding bladder capacity during urgency,the experimental group recorded(385.65±41.58)ml,whereas the control group had(351.25±35.19)ml.The bladder compliance figures for the experimental and control groups were(43.85±7.12)ml/cmH_(2)O and(32.58±5.28)ml/cmH_(2)O,respectively.After treatment,there was an increase in both bladder capacity and compliance during urgency for both groups(P<0.05).Notably,the experimental group showed significantly higher values for both these parameters compared to the control group(P<0.05).The incidence rate of post-operative urinary retention was 8.44%(3/37)in the experimental group and 35.14%(13/37)in the control group.This difference was statistically significant,with a correctedχ^(2)value of 7.974(P=0.005).Conclusion Laparoscopic PKRP combined with PMHR during the same period can promote recovery and relieve pain in elderly patients with IIH combined with BPH,and at the same time can improve urodynamics,and reduce the incidence of urinary retention.