老年患者嵌顿性股疝伴肠坏死的局部麻醉手术临床体会
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摘要
<正>股疝发病率较低,约占腹外疝的3%～5%[1],多发生在老年女性患者中,嵌顿率较高,一旦发生嵌顿需要手术治疗。老年患者一般伴有多种疾病,越是高龄患者实施手术风险越大,往往因凝血功能异常或伴心肺功能异常,不适宜接受硬膜外麻醉,若采取全麻则术后患者恢复慢,增加死亡的风险[2]。采取局麻可以相应减少麻醉带来的副作用,患者应激小,术后利于恢复,相对安全。随着我国老年患者逐年增多,股疝的发病例数也随之增高[3],相应的股疝伴嵌顿的数量也在增加,本文
引文
[1] 刘素君, 陈杰, 王帆, 等. 局麻下股疝的术式选择及手术技巧[J]. 中华普通外科杂志, 2010, 25(8): 661-664. DOI: 10.3760/cma.j.issn.1007-631X.2010.08.019. Liu SJ, Chen J, Wang F, et al. Femoral hernia repair under local anesthesia[J]. Chin J Gen Surg, 2010, 25(8): 661-664. DOI: 10.3760/cma.j.issn.1007-631X.2010.08.019.
[2] 朱雷, 唐文皓, 唐健雄, 等. 成人腹股沟嵌顿疝和绞窄疝的急诊手术[J]. Chin J Gen Surg, 2016, 43(10): 712-715. DOI: 10.3760/cma.j.issn.1673-4203.2016.10.022. Zhu L, Tang WH, Tang JX, et al. Emergency surgery of groin incarcerated hernia and strangulated hernia in adults[J]. Chin J Gen Surg, 2016, 43(10): 712-715. DOI: 10.3760/cma.j.issn.1673-4203.2016.10.022.
[3] 何智勇, 苏志坚. 老年嵌顿性腹股沟疝患者肠缺血坏死的危险因素[J]. 中国老年学杂志, 2016, 36(20): 5092-5093. DOI: 10.3969/j.issn.1005-9202.2016.20.072. He ZY, Su ZJ. Risk factors of intestinal ischemic necrosis in elderly patients with incarcerated inguinal hernia[J]. Chin J Gerontol, 2016, 36(20): 5092-5093. DOI: 10.3969/j.issn.1005-9202.2016.20.072.
[4] Chia CF, Chan WH, Yau KW, et al. Emergency femoral hernia repair: 13-year retrospective comparison of the three classical open surgical approaches[J]. Hernia, 2017, 21(1): 89-93. DOI: 10.1007/s10029-016-1549-8.
[5] 黄忠明, 朱光辉, 姚凯, 等. 嵌顿性股疝肠坏死的危险因素分析[J]. 蚌埠医学院学报, 2015, 40(12): 1673-1674, 1677. DOI: 10.13898/j.cnki.issn.1000-2200.2015.12.019. Huang ZM, Zhu GH, Yao K, et al. Risk factors for intestinal necrosis of incarcerated femoral hernia[J]. J Bengbu Med Coll, 2015, 40(12): 1673-1674, 1677. DOI: 10.13898/j.cnki.issn.1000-2200.2015.12.019.
[6] 中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝诊疗指南(2012年版)[J]. 中华外科杂志, 2013, 51(1): 4-6. DOI: 10.3760/cma.j.issn.0529-5815.2013.01.002. Hernia and Abdominal Surgery Group, Surgical Society of Chinese Medical Association. Guidelines for the diagnosis and treatment of adult inguinal hernia (2012 edition)[J]. Chin J Surg, 2013, 51(1): 4-6. DOI: 10.3760/cma.j.issn.0529-5815.2013.01.002.
[7] 李建华, 陈杰, 申英末. 局麻下无张力疝修补术在成人股疝治疗中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2008, 2(2): 206-208. DOI: 10.3969/j.issn.1674-392X.2008.02.020. Li JH, Chen J, Shen YM. Application of tension-free repair in adult patients with femoral hernia under local anaesthesia[J]. Chin J Hernia Abdom Wall Surg(Electron Ed), 2008, 2(2): 206-208. DOI: 10.3969/j.issn.1674-392X.2008.02.020.
[8] 杨东, 王荫龙. 股疝的治疗策略(附170例报告)[J]. 中国中西医结合外科杂志, 2015, 21(6): 581-584. DOI: 10.3969/j.issn.1007-6948.2015.06.010. Yang D, Wang YL. Treatment strategies of femoral hernia (report of 170 cases)[J]. Chin J Surg Integr Tradit Western Med, 2015, 21(6): 581-584. DOI: 10.3969/j.issn.1007-6948.2015.06.010.
[9] Kim G, Yan So JB, Shabbir A. Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction[J]. Int J Surg Case Rep, 2017, 32: 16-18. DOI: 10.1016/j.ijscr.2017.01.034.
[2] 朱雷, 唐文皓, 唐健雄, 等. 成人腹股沟嵌顿疝和绞窄疝的急诊手术[J]. Chin J Gen Surg, 2016, 43(10): 712-715. DOI: 10.3760/cma.j.issn.1673-4203.2016.10.022. Zhu L, Tang WH, Tang JX, et al. Emergency surgery of groin incarcerated hernia and strangulated hernia in adults[J]. Chin J Gen Surg, 2016, 43(10): 712-715. DOI: 10.3760/cma.j.issn.1673-4203.2016.10.022.
[3] 何智勇, 苏志坚. 老年嵌顿性腹股沟疝患者肠缺血坏死的危险因素[J]. 中国老年学杂志, 2016, 36(20): 5092-5093. DOI: 10.3969/j.issn.1005-9202.2016.20.072. He ZY, Su ZJ. Risk factors of intestinal ischemic necrosis in elderly patients with incarcerated inguinal hernia[J]. Chin J Gerontol, 2016, 36(20): 5092-5093. DOI: 10.3969/j.issn.1005-9202.2016.20.072.
[4] Chia CF, Chan WH, Yau KW, et al. Emergency femoral hernia repair: 13-year retrospective comparison of the three classical open surgical approaches[J]. Hernia, 2017, 21(1): 89-93. DOI: 10.1007/s10029-016-1549-8.
[5] 黄忠明, 朱光辉, 姚凯, 等. 嵌顿性股疝肠坏死的危险因素分析[J]. 蚌埠医学院学报, 2015, 40(12): 1673-1674, 1677. DOI: 10.13898/j.cnki.issn.1000-2200.2015.12.019. Huang ZM, Zhu GH, Yao K, et al. Risk factors for intestinal necrosis of incarcerated femoral hernia[J]. J Bengbu Med Coll, 2015, 40(12): 1673-1674, 1677. DOI: 10.13898/j.cnki.issn.1000-2200.2015.12.019.
[6] 中华医学会外科学分会疝和腹壁外科学组. 成人腹股沟疝诊疗指南(2012年版)[J]. 中华外科杂志, 2013, 51(1): 4-6. DOI: 10.3760/cma.j.issn.0529-5815.2013.01.002. Hernia and Abdominal Surgery Group, Surgical Society of Chinese Medical Association. Guidelines for the diagnosis and treatment of adult inguinal hernia (2012 edition)[J]. Chin J Surg, 2013, 51(1): 4-6. DOI: 10.3760/cma.j.issn.0529-5815.2013.01.002.
[7] 李建华, 陈杰, 申英末. 局麻下无张力疝修补术在成人股疝治疗中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2008, 2(2): 206-208. DOI: 10.3969/j.issn.1674-392X.2008.02.020. Li JH, Chen J, Shen YM. Application of tension-free repair in adult patients with femoral hernia under local anaesthesia[J]. Chin J Hernia Abdom Wall Surg(Electron Ed), 2008, 2(2): 206-208. DOI: 10.3969/j.issn.1674-392X.2008.02.020.
[8] 杨东, 王荫龙. 股疝的治疗策略(附170例报告)[J]. 中国中西医结合外科杂志, 2015, 21(6): 581-584. DOI: 10.3969/j.issn.1007-6948.2015.06.010. Yang D, Wang YL. Treatment strategies of femoral hernia (report of 170 cases)[J]. Chin J Surg Integr Tradit Western Med, 2015, 21(6): 581-584. DOI: 10.3969/j.issn.1007-6948.2015.06.010.
[9] Kim G, Yan So JB, Shabbir A. Totally extra-peritoneal repair for acute incarcerated femoral hernia with intestinal obstruction[J]. Int J Surg Case Rep, 2017, 32: 16-18. DOI: 10.1016/j.ijscr.2017.01.034.