不同麻醉方式下老年腹股沟疝修补术343例

Retrospective analysis of 343 elderly patients with inguinal hernia repair under different anaesthesias

目的探讨老年腹股沟疝修补术的最佳麻醉方式及其临床意义。方法采集川北医学院附属医院2006年9月至2011年5月收治的343例老年原发非嵌顿性腹股沟疝开放性手术患者的资料,按照麻醉方式分为局部麻醉组(A组)、椎管内麻醉组(B组)和全身麻醉组(C组)。观察比较手术时间、手术加麻醉时间、术中失血量、术中与术后并发症、术后住院时间、住院费用以及术后近期复发情况。结果手术时间:C组长于A组和B组,差异有统计学意义(t=2.366、2.308,P=0.019、0.023)。手术加麻醉时间:A组短于B、C二组,差异有统计学意义(t=-6.975、-7.307,P均=0.000),B组短于C组,差异有统计学意义(t=-2.129,P=0.035)。术中失血量:C组显著多于A、B组,差异有统计学意义(t=3.883、4.000,P均=0.000)。术中术后并发症:A、B组均少于C组,差异有统计学意义(χ2=6.722、6.536,P=0.010、0.011)。术后住院时间:C组与A、B组之间差异无统计学意义(t=0.761、0.953,P=0.448、0.341)。住院费用:A组低于B、C组,差异有统计学意义(t=-9.714、-20.000,P均=0.000),B组低于C组,差异有统计学意义(t=-12.898,P=0.000)。术后住院期间三组患者均无复发。结论局部麻醉下对老年原发非嵌顿性腹股沟疝患者行开放性疝修补术,操作简单、疗效可靠、安全性高、费用低廉,应予推广采用。

Objective To discuss the best choice for anesthesia of elderly patients with inguinal hernia repair and its clinical significance. Methods Retrospective analysis was made in 343 60 years old or above patients who had either local, intravertebral or general anesthesia in open inguinal hernia repair （named group A, group B and group C successively）. The primary endpoints were operation duration, operation and anesthesia duration, bleeding volume intraoperation, complications during and after operation, hospital stays postoperation, hospital expense and early recurrence postoperation. Results The operation durations of group A and B were both significantly shorter than group C （ t = 2. 366, 2. 308, P -- 0. 019, 0. 023）. Group A owned significantly shorter operation and anesthesia duration compared to group B and C （ t = - 6. 975, - 7. 307, both P = 0. 000）, and that of group B was remarkably shorter than group C （ t = -2. 129 ,P = 0. 035 ）. The bleeding volumes intraoperation of group A and B were less than group C （t = 3. 883,4. 000, both P = 0. 000）. The intraoperative and postoperative complications of group A and B were less than group C ~2 = 6. 722, 6. 536,P = 0. 010, 0.011 ）. There were no significant differences of hospital stays between group A, B and group C （t = 0. 761, 0. 953, P = O. 448, 0. 341）. The hospital expense of group A was lower than group B and C （t = -9. 714, -20.000, both P = O. 000）, and group B was lower than group C （t = 12. 898,P = 0. 000）. There were no recurrences before discharge in the three groups. Conclusions Open inguinal hernia repair under local anesthesia for elderly patients with primary and non-incarcerated inguinal hernia is characterized with simplicity, good effect, high safety and low cost and worthy of clinical adoption and promotion.