局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补术

Open Preperitoneal Groin tension-free hernioplasty under local nerve blockade anaesthesia

目的探讨局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补的应用。方法采用美国强生公司生产的普理灵疝装置、美国巴德公司生产的Kugel补片及网塞和德国贝朗公司生产的大号自主成型补片作为疝修补材料,对2002年2月至2005年6月间收治的1723例腹股沟疝患者进行局部神阻滞麻醉下的腹膜前腹股沟无张力疝修补,观察手术时间,术后并发症,手术费用,平均住院日和近期随访情况。结果手术时间平均28 min,未出现尿潴留,阴囊浆液肿46例。本组患者围手术期死亡3例,切口感染1例,切口下血肿14例,术后慢性疼痛5例,平均住院日3 d,平均手术费用4766元。平均随访45个月,复发4例,异物感不明显。结论局部神经阻滞麻醉下的腹膜前腹股沟无张力疝修补是一种安全、可靠的手术方式,尤其适用于疝环或腹横筋膜缺损较大的腹股沟疝老年患者。

Objective To evaluate the application of open preperitoneal groin tension-free hernioplasty under local nerve blockade anaesthesia. Methods One thousand seven hundreds twenty three patients with preperitoneal groin tension-free hernioplasty under local nerve blockade anaesthesia from Feb 2002 to Jun 2006 in our center were analyzed. Results The operative time was 15 to 60 minutes, average time was 28 minutes. All patients had slight wound pain after operation, no one used anesthetic. Three cases was died during the stay in hospital, One case had the wound infection, no one had urinary retention, the Scrotal hydroceles were 46 cases, the chronic pain was 5 cases, the average stay in hospital were 3 days, the average cost was 4766 yuan （ RMB）, 4 cases had recurrence and no one had the feeling of foreign body follow-up average 45 months. Conclusions The open preperitoneal groin tension-free hemioplasty under local nerve blockade anaesthesia was a safe and credible operative method, especially for the old patients with inguinal hernia who has large hernia ring or defect of transversalis fascia （TF）.