区域神经阻滞麻醉下老年腹股沟疝腹膜前修补术日间手术模式的临床应用

Clinical application of preperitoneal herniorrhaphy under the local nerve block anesthesia in the form of day-surgery

目的探讨区域神经阻滞麻醉下老年腹股沟疝腹膜前修补术在日间手术模式下的安全性及有效性。方法回顾性分析2014年4月-2015年4月在上海交通大学医学院附属仁济医院南院区域神经阻滞麻醉下行日间腹股沟疝改良腹膜前修补术的58例老年患者的临床资料，同期的58例老年患者住院手术作为对照组，分析手术时间、住院天数、术后并发症、住院费用等情况。结果日间组平均手术时间为（47±12）min，56例达成日间手术标准，于术后24h出院。2例于术后48h出院，平均住院费用为8437元。术后近期并发症发病率为6．6％（4／58），其中阴囊血肿3例，尿潴留1例，术后6hVAS疼痛评分为（2．4±0．8）分。随访12个月，其中仅1例出现轻微慢性疼痛。结论区域神经阻滞麻醉下日间老年腹股沟疝腹膜前修补术安全有效，能明显缩短住院时间、减少住院费用，可以在日间手术中心推广开展。

Objective To assess the safety and efficacy of the local nerve block anesthesia procedure in day- surgery inguinal herniorrhaphy practice. Methods Fifty-eight inguinal herniorrhaphy were performed under the lo- cal nerve block anesthesia in the form of day surgery between April 2014 and April 2015 other 58 inguinal hernior- rhaphy were performed under general anesthesia. Time of operation, hospitalization stay, complications and costs were evaluated. Results The average operating time of the day-surgery group was （47 -＋ 12） min. All operations were completed successfully. Fifty-six patients were discharged in 24 hours and 2 patients were discharged in 48 hours after the surgery. The average costs were 8437 yuan. The rate of postoperative complications was approxi- mately 6.6% （4/58） , including hematoma（3 cases） , urinary relention（ 1 case） , and chronic pain （ 1 case）. The VAS scores of 6 hours after the operation were （2.4 ±0.8 ）. Condusions It suggests that preperitoneal hemior- rhaphy under the local nerve block anesthesia in the form of day-surgery was safe and effective. Also, it could sig- nificantly shorten the time of hospitalization and reduce medical costs.