局麻下股疝的术式选择及手术技巧

目的 探讨局麻下股疝无张力修补的术式选择及改良腹膜前修补手术技巧.方法 2002年12月至2009年12月收治109例非绞窄性股疝,按时间段分为3组,其中2002年12月至2008年12月85例,45例为腹膜前修补组(preperitoneal组),40例为网塞修补组(plug组);2009年1月至2009年12月24例为改良腹膜前修补组.分别对3组患者手术时间、住院天数、术后疼痛评分(VAS)、局部异物感、术后复发率及切口血清肿等指标进行分析比较.结果 109例患者均在局麻下完成无张力疝修补术,围手术期无死亡病例.preperitoneal组在术后切口血清肿、局部异物感及复发率等方面均明显优于plug组(P＜0.05);改良腹膜前修补组在手术时间、住院天数及术后VAS等方面又明显优于preperitoneal组(P＜0.05).结论 非绞窄性股疝应选择局麻下改良腹膜前修补术.改良腹膜前修补术创伤更小、手术时间更短、术后恢复更快.

Femoral hernia repair under local anesthesia

Objective To evaluate the choices and surgical skills for tension-free femoral hernia repair under local anesthesia. Methods The clinical data of 109 nonincarcerated femoral hernia patients were summarized from December 2002 to December 2009. Patients were divided into 3 groups according the time period at which the surgery was performed. 85 patients from 2002 to 2008 were divided into 2 groups,45 cases treated with preperitoneal repair ( preperitoneal group), and the other 40 cases with mesh-plug repair (plug group). The 24 cases admitted from January 2009 to December 2009 received modified preperitoneal repair. Operation time, VAS, length of hospitalization, incidence of recurrence, foreign body feelings and seroma were compared among the three groups. Results All the 109 patients were repaired under local anesthesia, and there was no perioperative death. The statistical indicator value of incidence of recurrence, foreign body sensation and seroma in preperitoneal group was lower than plug group (P ＜0.05). The modified preperitoneal repair was better in operation time, VAS, length of hospitalization than preperitoneal group (P ＜ 0.05). Conclusions Modified preperitoneal repair under local anesthesia is the choice for treating femoral hernia without incarceration. Modified preperitoneal repair is faster, more minimally invasive and faster recovery.