局麻与硬膜外麻醉下聚丙烯材料补片应用腹股沟疝修补术效果及慢性疼痛调查--基层医院经验  

Comparison of efficacy of spinal anaesthesia and sub-fascial local anaesthetic inguinal field block for open inguinal hernia repair in a primary hospital

作　　者：刘国华 卢伟坚 廖波 程峰宝 李开峰 LIU Guohua;LU Weijian;LIAO Bo;CHENG Fengbao, LI Kaifeng(Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China ;Zhaoping People＇s Hospital, Hezhou, 542800, China)

机构地区：[1]广东医科大学附属医院科肝胆外科,广东湛江524000 [2]昭平县人民医院,广西贺州546800

出　　处：《岭南现代临床外科》2018年第5期562-565,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的对比分析局麻与硬外麻醉下无张力修补术治疗腹股沟疝疗效,探讨基层医院在有限条件下治疗腹股沟疝更适宜的麻醉方式。方法采用前瞻性研究方法,纳入研究的患者为2016年7月至2017年1月半年来收治的102例腹股沟疝所有患者分成局麻组与硬外麻组,两组均采用疝囊高位结扎+平片无张力修补术,比较两组手术时间、术后伤口疼痛时间、术后不良反应和并发症的发生和差异;记录术后患者对麻醉效果的满意度;出院后嘱病人1周后回院复查1次,1个月、6个月、12个月、24个月电话随访1次。结果两组皮下血肿、术后伤口感染、阴囊肿胀、腹股沟神经与腹腔脏器损伤、术后伤口疼痛时间差异无统计学意义(P>0.05),局麻组住院时间、住院费用、恶心/呕吐、头昏/头痛、尿潴留并发症发生率均比硬外麻组低或少,两组差异有统计学意义(P<0.05)。两组患者在2年随访中各有2例出现腹股沟区疼痛,服用NSAIDs类药物好转。两组术后1月、6月、12月和24月VAS评分结果,其差异没有统计学意义(表3)。两组患者对手术中麻醉满意情况见表4,硬膜外组满意患者多于局麻组。结论基层医院实施局麻下开放式腹股沟疝平片无张力修补术可行,也不增加慢性疼痛的发生。Objetive To investigate the most suitable anaesthesia method for the tension-fiee hernior rhaphy in the primary hospitals under the linfited condition by comparative study of the effect of local anesthesia and epidural anesthesia in tension-fi-ee repair of inguinal hernia. Methods A total of 102 unilateral inguinal hernia cases from July 2016 to January 2017 were collected and divided into the local anaesthesia group and epidural anaesthesia group. All patients in two groups ,were operated with high ligation of hernia sac and flat mesh repair of inguinal hernia. The operation time and postoperative wound pain time, postoperative adverse reactions and complications ,were compared between the two groups. The postoperative patients＇ satisfaction with the anesthetic effect ,was recorded. After the discharge , the patients were reviewed once a week in the first month. Telephone follow-up ,was performed once a month for two years. Results There ,was no significant difference of subcutaneous hematoma, wound infection, serotal swelling, inguinal nerve and abdominal organ injury and the duration of post-operative pain between two groups （P〉0.05）. It ,was found that hospital stay and the oeeun＇enee of complication of Nausea/ vomiting, Headache/dizzy, and urosehesis in local anaesthesia group were significantly lessor lower than those in epidural anaesthesia group （ P〈0.05 ）. Two patients had chronic pain in each group during the 2-year follow-up, and were improved by NSAIDs. There were no statistically significant differences inVAS scores between the two groups at 1 month, 6 months, 12 months, and 24 months （Table 3）. The patients in the epidural group were more satisfied anesthesia than those in the local anesthesia group. Conclusion It is feasible to perform tension-fiee repair of open inguinal hernia under local anesthesia in primary hospitals, and it does not increase the incidence of chronic pain.

关 键 词：腹股沟疝 无张力修补术 局部麻醉 硬外麻醉 

分 类 号：R656.21[医药卫生—外科学]