高龄高危良性前列腺增生患者合并腹股沟疝的同期手术治疗体会

Synchronal surgery of benign prostatic hyperplasia with inguinal hernia in high-risk elderly patients

目的 探讨高龄高危良性前列腺增生（BPH）合并腹股沟疝的同期手术方法及其治疗效果并总结经验.方法 回顾性分析2006年8月至2011年10月收治的46例高龄高危良性前列腺增生合并腹股沟疝患者的临床资料,采用前列腺选择性绿激光汽化术（PVP）联合经尿道前列腺电切术（TURP）处理增生的前列腺组织,选用聚丙烯单丝补片（美国巴德公司）进行腹股沟疝无张力修补术.结果 本组46例随访5～48个月,无一例疝复发,无切口感染、尿失禁、经尿道电切综合征及尿道狭窄.3例出现腹股沟区不适感,2例切口脂肪液化,6例轻度尿路刺激征,4例短暂排尿困难,上述并发症对症处理后治愈.结论 PVP联合TURP加无张力疝修补术处理高龄高危良性前列腺增生患者合并腹股沟疝,一期手术完成,创伤小,出血少,手术时间短,避免了二次麻醉风险和手术打击.

Objective To explore the method of synchronal surgery of benign prostatic hyperplasia（BPH） with inguinal hernia in high-risk elderly patients and summarize the experience. Methods The clinical data of 46 high-risk elderly patients with BPH and inguinal hernia from Aug. 2006 to Oct. 2011 were retrospectively analyzed. Hyperplastic prostate tissues were removed by photoselective vaporization of prostate（PVP） and transurethral resection of prostate（ TURP）. Tension-free hernioplasty with monofilament polypropylene patch was used to repair inguinal hernia. Results All the 46 patients were followed up for 5 -48 months. There was no hernia recurrence, incision infection, uroclepsia, transurethral resection syn- drome or urethral stricture. There was discomfort in inguinal region in 3 cases ,fat liquefaction of incision in 2 cases, mild urinary irritation in 6 cases and transient dysuria in 4 cases;The cases mentioned above were cured via symptomatic treatment. Conclusion The combination of PVP, TURP and tension-free hernio- plasty has advantages of minor invasion,less blood loss and shorter operative time in the treatment of BPH with inguinal hernia in high-risk elderly patients. It~ a one-stage surgery and avoids risks of secondary anesthesia and operation.