微小切口局麻下腹股沟无张力疝修补日间手术124例体会

Experience of micro-incision day surgery for tension-free herniorrhaphy under local anesthesia in 124 cases

目的评估微小切口局麻下腹股沟无张力疝修补日间手术的疗效并总结临床经验。方法回顾性分析2012年3月至2016年12月,南京中医药大学附属南京市中西医结合医院124例行微小切口局麻下腹股沟无张力疝修补日间手术患者的临床资料。结果本组患者均顺利完成手术,平均手术时间38 min,住院时间1 d。术后切口血肿1例,阴囊浆液肿5例,顽固疼痛2例,术后随访3~60个月,未发现术后复发、感染等并发症。住院时间及费用较常规手术大幅减少。结论开展腹股沟疝日间手术,能大幅度降低费用,缩短诊治时间;局部麻醉能保证手术顺利进行;微小切口创伤小,术后切口瘢痕小,且能满足安全手术要求,不影响术野暴露;可推广日间疝修补手术,但需进一步制定可行方案,规范化治疗。

Objective To assess the effectiveness of micro-incision day surgery for tension-free herniorrhaphy under local anesthesia and summarize the clinical treatment experience. Methods A total of 124 patients with inguinal hernia in Nanjing Integrated Traditional Chinese and Western Medicine Hospital who were treated with tension-free herniorrhaphy under local anesthesia via micro-incision day surgery from March 2012 to December 2016 were retrospectively analyzed. Results The mean operation time was 38 minutes. The hospitalization time was 1 day. There was 1 case of subcutaneous hematoma,5 cases of scrotal seroma and 2 cases of chronic pain. The follow-up lasted 3 to 60 months,there was no complication such as recurrence,wound infection,etc.. Meanwhile,patients spend less costs and length of hospital stay than inpatient surgery.Conclusions Day surgery for tension-free herniorrhaphy can reduce the expense and shorten the treatment time. Local anesthesia can ensure the operation going smoothly; micro-incision has less trauma and scars,can meet the requirements of safe operation,and do not influence operative field exposure. It can be widely used,but need to further develop feasible programs and implement standardized treatment.