TUVP联合腹股沟疝无张力修补术同期治疗老年BPH并腹股沟疝的疗效观察

目的：探讨经尿道前列腺汽化电切联合腹股沟疝无张力修补术同期治疗老年BPH合并腹股沟疝的方法和可行性。方法：2006年1月-2012年6月，共65例患者纳入本研究，平均年龄76岁。术前评估患者国际前列腺症状评分（IPSS）、生活质量（QOL）评分，行血清前列腺特异抗原、经直肠超声、剩余尿量以及尿流动力学检查。所有患者均先行经尿道前列腺手术再行疝修补术，其中61例行开放无张力修补术（疝环填充法），4例行腹腔镜疝修补。术后定期随访。结果：65例患者中，腹股沟斜疝48例（单侧41例、双侧7例），腹股沟直疝17例。手术顺利，平均耗时95min，未发生严重术中、术后并发症。术后IPSS评分平均为（8．0±1．2），与术前（24．7±4．5）相比明显下降（P〈0．05）；最大尿流率（Qmax）平均为（18．0±1．2）ml／s，较术前（6．5±0．7）ml／s明显增高（P〈0．05）；剩余尿量减少至0～35ml。腹股沟疝手术切口均为I／甲愈合。未发生手术切口感染，术后远期无腹股沟疝复发。结论：同期经尿道前列腺电切联合腹股沟疝无张力修补术对BPH合并腹股沟疝患者具有较为满意的治疗效果，是老年患者较为理想的手术方式。在临床应用过程中，需要严格掌握同期手术的适应证，选择合适的患者，注意严格规范的无菌操作，推荐先进行腔内前列腺手术。

Concurrent therapy of TUVP and tension-free inguinal hernia repair for senior BPH patients combined with inguinal hernia

Objective： To evaluate the efficacy of concurrent therapy of transurethral vaporization of the pros-tate （TUVP） and tension-free inguinal hernia repair for senior benign prostatic hyperplasia （BPH） patients com-bined with inguinal hernia. Method： From January 2006 to June 2012, 65 patients were enrolled in the study with a mean age of 76 years. Preoperative evaluations were performed in all patients including International Prostate Symptom Score （IPSS） and Quality of Life （QOL） scale. Serum prostate specific antigen, transrectal uhrasonog- raphy, postvoid residual volume （PVR） and urodynamic examination were performed. Inguinal hernia repair was performed after TUVP. Sixty-one cases received open surgery while other four cases underwent laparoscopic sur-gery. Regular postoperative follow-up plan was performed in all cases. Result： Among these cases, 48 were diag-nosed as oblique inguinal hernia （41 were unilateral and 7 were bilateral） and 17 were direct inguinal hernia. The mean operative time was 95 rain, and no severe complications was found. The mean postoperative IPSS was （8.0 ±1.2）, which was significantly decreased. The mean Qmax was increased postoperatively （18. 0 ±1.2） ml/s. Postvoid residual volume decreased to 0-35 ml. Wound infection and recurrent inguinal hernia did not appear. Con- elusion： Concurrent therapy of TUVP and tension-free inguinal hernia repair is safe and efficient for the treatment of senior BPH patients combined with inguinal hernia. Surgeons and physicians should pay attention to the indica- tions and appropriate patients. Moreover, aseptic technique is crucial. Transurethral prostate surgery should be performed before inguinal hernia repair.