探讨局部麻醉与硬膜外麻醉下自黏性补片应用于腹股沟疝修补术中的临床研究。

回顾性收集2014年2月至2018年10月于安徽省第二人民医院普外科使用自黏性补片进行腹股沟疝修补术治疗的100例患者的临床资料。据麻醉方式分为局部麻醉组和硬膜外麻醉组。其中，局部麻醉组80例，硬膜外麻醉组20例。比较2组术后手术指标、疼痛评分、住院指标、术后并发症及复发情况；术前及术后1周的炎性因子水平。计量资料使用（±s）表示，使用t检验进行比较。计数资料使用频数表示，χ²检验或Fisher检验进行比较。

局部麻醉组腹股沟疝患者手术时间、术后下床时间、进食时间、住院时间分别为（51.59±8.29）min、（7.61±0.95）h、（5.44±0.61）h和（2.50±0.87）d，与硬膜外麻醉组（44.86±6.13）min、（8.82±1.14）h、（8.26±0.92）h和（4.17±1.05）d比较，差异均有统计学意义（P<0.05）。局部麻醉组腹股沟疝患者术后4 h视觉模拟评分为（4.02±0.52）分，与对照组（3.95±0.38）分比较，差异无统计学意义（P>0.05）。局部麻醉组住院费用（3852.17±415.26）元，少于硬膜外麻醉组（4650.36±453.91）元，差异有统计学意义（P<0.05）。局部麻醉组患者术后尿潴留发生率1例（1.25%）低于硬膜外麻醉组3例（15.00%），差异有统计学意义（P<0.05）；但局部麻醉组术后切口感染情况为6例（7.50%），低于硬膜外麻醉组4例（20.00%），差异无统计学意义（P>0.05）。术后均无复发。术后1周较术前比较，2组血清白介素-6、肿瘤坏死因子-α水平均降低，且局部麻醉组低于硬膜外麻醉组，差异有统计学意义（P<0.05）。

局部麻醉相较硬膜外麻醉下应用自黏性补片进行腹股沟疝修补术可有效抑制患者术后早期的炎症反应，促进术后康复，还可减轻患者治疗负担，减少尿潴留的发生，且两者镇痛效果相当，建议临床推广。

To study the clinical effect of the application of the self-gripping mesh for inguinal hernia repair under local anesthesia and epidural anesthesia.

The clinical data of 100 patients treated by using the self-gripping mesh in the Anhui No.2 Provincial People's Hospital between February 2014 and October 2018 were retrospectively collected. They were divided into the local anesthesia group (n=80) and the epidural anesthesia group (n=20). The postoperative operation index, pain score, hospitalization index, postoperative complications and recurrence were compared between the two groups. And the levels of inflammatory factors before operation and 1 week after operation were compared between the two groups. The measurement data are expressed using (±s) and compared using t tests. The counting data are represented by frequency, compared χ² tests or Fisher tests.

The operation time of the local anesthesia group was longer than that of the epidural anesthesia group, and the leaving bed time and eat time of the local anesthesia group was shorter than those of the epidural anesthesia group, with significant differences (P<0.05). The postoperative 4 h visual analogue scale scores of the two groups had no statistical difference (P>0.05), and the hospital stay and cost in the local anesthesia group were less than those of the epidural anesthesia group, with significant differences (P<0.05). The incidence of postoperative urine retention in the local anesthesia group was lower than that of the epidural anesthesia group, with significant differences (P<0.05). However, the postoperative incision infection rate and the postoperative recurrence rate of the two groups were not statistically different (P>0.05). At 1 week after operation, the levels of interleukin-6, and tumor necrosis factor-α in the two groups decreased, and those of the local anesthesia group was lower than those of the epidural anesthesia group, with significant differences (P<0.05).

The application of the self-gripping mesh in the inguinal hernia repair under local anesthesia can effectively inhibit the early postoperative inflammatory reaction of the patient, promote the postoperative rehabilitation, and also can reduce the treatment burden of the patient, reduce the occurrence of the urine retention, and the pain-relieving effect of the two patients is comparable, which is worth for clinical promotion.