局部麻醉下腹股沟疝无张力修补术在高龄患者中的应用

doi:10.3877/cma.j.issn.1674-392X.2021.03.013

目的

探讨局部麻醉下高龄患者行腹股沟疝无张力补修术的安全性以及有效性。

方法

选择2016年3月至2019年3月，广安市人民医院在局部麻醉下行腹股沟疝无张力修补术126例高龄患者的临床资料，分析住院时间、术后并发症及住院费用情况。

结果

手术时间为35～74 min，平均（43.4±12.1）min，于术后48 h之内出院患者99例（78.6%），于术后72 h出院20例（15.9%），于术后3～12 d出院患者7例（5.6%），住院时间（2.1±0.6）d，住院费用（3932±267）元。离院后失访患者5例，术后并发症患者8例（5.4%），术后出现切口浆液渗出患者3例（2.4%），出现阴囊血肿患者1例（0.8%），术后发热患者2例（1.6%），术后切口血肿患者1例（0.8%），因术后反复尿潴留复发患者1例（0.8%）。术后4 h的疼痛视觉模拟评分（VAS）为（3.1±1.4）分，术后3 d的VAS评分为（1.6±0.6）分。术后的第1天出现疼痛、恶心、紧张等不适症状患者28例（22.2%），第3天5例（4.0%），差异有统计学意义（P<0.05）。

结论

短期临床观察，高龄患者在局部麻醉下行腹股沟疝无张力修补术是安全有效的。

关键词: 疝，腹股沟, 疝修补术, 麻醉，局部, 神经阻滞, 高龄

Objective

The aim of this study is to evaluate the feasibility and the safety of hernioplasty under local anesthesia in elderly patients.

Methods

A total of 126 elderly patients underwent inguinal hernia repair with mesh under local anesthesia in Guang'an people's hospital between March 2016 and March 2019. Length of hospitalization stay, hospitalization costs and complications were evaluated.

Results

The operation time was 35 to 74 minutes, with an average of (43.4±12.1) minutes; 99 patients (78.6%) were discharged within 48 hours after operation, 20 patients (15.9%) were discharged within 72 hours after operation, and 7 patients (5.6%) were discharged in 3 to 12 days after operation; The length of hospital stay was (2.1±0.6) days, and hospitalization expenses was (3 932±267) yuan. Five patients lost to follow-up after operation, eight patients had postoperative complications (5.4%), three patients (2.4%) had postoperative wound serous exudate, 1 patient (0.8%) had scrotal hematoma, 2 patients (1.6%) had postoperative fever, 1 patient (0.8%) had postoperative hematoma, and 1 patient (0.8%) had recurrence due to repeated urinary retention. The visual analogue scale (VAS) of pain at 4 hours after operation was (3.1±1.4) points. The VAS score at 3 days after operation was (1.6±0.6) points. There were 28 cases (22.2%) with pain, nausea, tension and other discomfort symptoms at the first day after operation, and 5 cases (4.0%) at the third day after operation, the difference was statistically significant (P<0.05).

Conclusions

After short term clinical observation, inguinal hernia repair with local anesthesia is feasible in older patients.

Key words: Hernia, inguinal, Herniorrhaphy, Anesthesia, local, Nerve block, Elderly patients

表1 局部麻醉下腹股沟疝修补术后轻度不适情况[例（%）]

症状	术后第1天	术后第3天
疼痛	24(19.0)	4(3.2)
恶心/呕吐	2(1.6)	1(0.8)
头晕	1(0.8)	0
紧张	1(0.8)	0
合计	28(22.2)	5(4.0)

表1 局部麻醉下腹股沟疝修补术后轻度不适情况[例（%）]

症状	术后第1天	术后第3天
疼痛	24(19.0)	4(3.2)
恶心/呕吐	2(1.6)	1(0.8)
头晕	1(0.8)	0
紧张	1(0.8)	0
合计	28(22.2)	5(4.0)

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Feasibility of inguinal hernioplasty under local anesthesia in elderly patients

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Feasibility of inguinal hernioplasty under local anesthesia in elderly patients