局部神经阻滞麻醉在腹股沟疝无张力修补中应用.docVIP

局部神经阻滞麻醉在腹股沟疝无张力修补中应用[摘要]目的探讨局部麻醉施行无张力疝修补术治疗腹股沟疝的可行性,并总结临床经验。方法局部麻醉下无张力疝修补术治疗腹股沟疝227例,对麻醉效果及手术时间、并发症和复发率进行回顾性分析。结果 病人术中疼痛耐受良好,平均手术时间51min, 3-24 h内可以下床活动,术后平均住院时间3. 8 d。术后出现肺部感染1例，尿潴留1例,浆液肿2例,阴囊血肿3例等，并发症发生率为4.4%(10/227) 。 结论局麻下行无张力疝修补术符合人体生理，术后恢复快、并发症少、疗效好，尤其对于高龄腹外疝同时并有内科疾病的患者，更显示出其优越性，值得临床推广。 [关键词]腹股沟疝; 无张力修补; 局部麻醉 [中图分类号] R614.3[文献标识码]A [文章编号] 1005-0515（2010）-12-012-02 Local nerve blockade anaesthesia for tension-free inguinal hernia repair LI Ya-ping，WANGJian，ZHENG Cheng-jun （People’s Hospital of Leshan，Leshan，614000，China） [Abstract]ObjectiveTo evaluate the feasibility of tension-free inguinal hernia repair under localanaes-thesia, and summarize the clinical experience in the treatment of inguinal hernia.MethodsTwo hundredand Twenty-Seven inguinal hernia repairs were performed under local anaesthesia. Intraoperative pain wasmeas-ured, the operative time, complications and recurrent ratewere reviewed retrospectively. ResultAll patientstolerated well under local anaesthesia, themean operative timewas 51 minutes. The patients restored the out-of-bed activity in 3-24 hours. The mean hospitalized duration was 3. 8 days.There were 1 casesof pulmonary infection ，1 casesofurine retention, 2 cases of serosity swelling, 3 casesofscro-tum hematoma，and others. The overall complication rate was 4.4%.ConclusionThe tension-free herniorrhaphy in local anesthesia is worth in clinic because of quick recovery，few complication and good efficacy，especially for the abdominal external hernia complicated with medicine diseases of elderly. [Keywords] Inguinal hernia; Tension-free repair;Local anaesthesia ; 腹股沟疝是中老年人常见病和多发病，自美国医师Lichtenstein首先于1986年首次提出无张力疝修补概念以来，经过20多年技术和材料的创新和发展，该术式目前已基本取代传统的疝修补术。我院自2005年12月～2010年8月采用局部神经阻滞麻醉方法行无张力疝修补术治疗成人腹股沟疝227例，均取得满意效果，现报道如下。 1 临床资料与方法 1.1 一般资料：本组227例，其中男219例，女8例，平均年龄61. 3(24～90)岁, 60岁以上占60.8% (138/227)。临床分型均为可复性疝（复发疝未入本组），单侧203例，其中斜疝163例，直疝28例，马鞍疝(斜疝合并直疝)12例；双侧24例，其中双侧均为斜疝19例，一侧斜疝另一侧直疝5例。参照中华医学会外科学分会疝和腹壁外科学组成人腹股沟疝分型[1]，