[1]刘世呈,吴淼,肖卫东,等.肿胀麻醉技术在腹股沟疝腹膜前间隙修补术中应用的回顾性分析[J].第三军医大学学报,2017,39(21):2110-2114.
 LIU Shicheng,WU Miao,XIAO Weidong,et al.Tumescent local anesthetic technique for preperitoneal tension-free hernioplasty: a retrospective study[J].J Third Mil Med Univ,2017,39(21):2110-2114.
点击复制

肿胀麻醉技术在腹股沟疝腹膜前间隙修补术中应用的回顾性分析(/HTML )
分享到:

《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
39卷
期数:
2017年第21期
页码:
2110-2114
栏目:
临床医学
出版日期:
2017-11-15

文章信息/Info

Title:
Tumescent local anesthetic technique for preperitoneal tension-free hernioplasty: a retrospective study
作者:
刘世呈吴淼肖卫东熊莉
宜宾市第二人民医院:胃肠疝外科,麻醉科
Author(s):
LIU Shicheng WU Miao XIAO Weidong XIONG Li

Department of Gastrointestinal Hernia Surgery, Department of Anesthesiology, Yibin Second People’s Hospital, Yibin, Sichuan Province, 646000, China

关键词:
腹股沟腹膜前间隙肿胀麻醉
Keywords:
hernia groin preperitoneal space tumescent anesthesia
分类号:
R181.23; R614.3; R656.21
文献标志码:
A
摘要:

目的     评价肿胀麻醉技术在腹股沟疝腹膜前间隙修补手术的疗效及安全性。方法     回顾性分析本院2012年1月至2016年3月诊断为腹股沟疝患者的临床资料。根据病例资料术中麻醉方法不同分为两组,采用0.5%利多卡因的常规局部麻醉(LA组)和采用肿胀麻醉(TLA组),均使用强生公司疝修补装置(ultrapro hernia system,UHS)补片行腹膜前间隙修补完成手术。以手术时间、术中利多卡因的使用剂量、术后镇痛效果持续时间、术后3 d疼痛消失例数、术后1 d止痛药使用例数、术后7 d疼痛发生例数,以及术后并发症发生率作安全性指标。结果      共筛选出86例术中采用常规局部麻醉的临床资料,98例术中采用肿胀麻醉的临床资料。两组的一般资料比较差异无统计学意义(P>0.05)。两组均顺利完成手术,未出现局麻中毒反应,术中均未更改麻醉方法。TLA组利多卡因使用量和手术时间明显低于LA组[(140±8)mg vs (278±9)mg;(41±7)min vs (48±7)min,P<0.01],术后镇痛持续时间长于LA组[(4.2±0.8)h vs (1.2±0.3)h, P<0.01],TLA组术后1 d使用镇痛药物的比例低于LA组(P<0.01),两组术后3 d疼痛消失例数、持续性疼痛发生率,术后并发症发生率差异均无统计学意义(P>005)。结论     肿胀麻醉在腹股沟疝腹膜前修补术中缩短了手术时间,减少了利多卡因用量,有良好的术中麻醉镇痛效果以及安全性,术后镇痛持续时间优于常规局部麻醉。

Abstract:

Objective     To evaluate the efficacy and safety of tumescent local anesthetic (TLA) technique for preperitoneal tension-free hernia repair. Methods     The clinical data of 184 patients with inguinal hernia undergoing surgical treatment in our hospital from January 2012 to March 2016 were collected and analyzed retrospectively. According to the different of intraoperative anesthetic methods, these patients were divided into local anesthetic group (normal local anesthesia with 0.5% lidocaine) and TLA group. Both groups were treated by ultrapro hernia system (UHS). The operative time, analgesia duration, incidence rate of persistent pain, use of medication in the first postoperative day, and the number of the cases with pain disappeared in 3 d after operation were taken as the efficacy variables, and the doses of lidocaine used, and postoperative complication rate were taken as the safety indicators. Results     There were 86 patients in the LA group and 98 patients in the TLA group enrolled in our study, and no significant differences were seen in the general data between them (P>0.05). Successful operation was obtained in both groups, and no side reactions of local anesthetic intoxication were seen in them. The mean doses of lidocaine consumed (140±8 vs 278±9 mg, P<0.01) were lower, and the mean operation time (41±7 vs 48±7 min, P<0.01) was shorter in the TLA group than the LA group. The TLA group had longer duration of analgesia (4.2±0.8 vs 1.2±0.3 h, P<0.01) and less use of analgesics (P<0.01) within 1 d postoperatively than the LA group. There were no significant differences in other parameters between the 2 groups. Conclusion     TLA in inguinal hernia repair can reduce the operative time and usage of lidocaine, and achieve sound safety and good intraoperative analgesic effect. What’s more, it has superior in analgesic duration to conventional anesthesia.

参考文献/References:

[1]PERE P, HARJU J, KAIRALUOMA P, et al. Randomized comparison of the feasibility of three anesthetic techniques for day-case open inguinal hernia repair[J]. J Clin Anesth, 2016, 34: 166-175. DOI: 10.1016/j.jclinane.2016.03.062.
[2]NARITA M, SAKANO S, OKAMOTO S, et al. Tumescent local anesthesia in inguinal herniorrhaphy with a PROLENE hernia system: original technique and results[J]. Am J Surg, 2009, 198(2): e27-e31. DOI: 10.1016/j.amjsurg.2008.11.045.
[3]ELBOGHDADLY K, CHIN K J. Local anesthetic systemic toxicity: Continuing Professional Development[J]. Can J Anesth, 2016, 63(3): 330-349. DOI:10.1007/S12630-015-0564-Z.
[4]LILLIS P J. The tumescent technique for liposuction surgery[J]. Dermatol Clin, 1990, 8(3): 439-450.
[5]赵李平, 王明刚, 杜晓扬, 等. 低浓度利多卡因肿胀麻醉在体表大面积病变组织切除中的应用[J]. 中国美容医学, 2010, 19(6): 830-831. DOI: 10.3969/j.issn.1008-6455.2010.06.023.
ZHAO L P, WANG M G, DU X Y, et al. Application of tumescent anesthesia with the lower lidocaine concentration in the surgical treatment of superficial large pathological tissue[J]. Chin J Aesth Med, 2010, 19(6): 830-831. DOI: 10.3969/ j.issn.10086455.2010.06.023.
[6]GUTOWSKI K A. Tumescent analgesia in plastic surgery[J]. Plast Reconstr Surg, 2014, 134(4 Suppl 2): 50S-57S. DOI: 10.1097/ PRS.0000000000000678.
[7]宋应寒, 雷文章. 腹股沟疝修补术局部浸润麻醉要点[J]. 中国实用外科杂志, 2014, 34(5): 462-463.
SONG Y H, LEI W Z. The key point of local infiltration anesthesia for inguinal hernia hernioplasty[J]. Chin J Prac Surg, 2014, 34(5): 462-463.
[8]AMID P K, SHULMAN A G, LICHTENSTEIN I L. Local anesthesia for inguinal hernia repair stepbystep procedure[J]. Ann Surg, 1994, 220(6): 735-737. DOI:10.1097/0000065819941200000004.
[9]TZONEVA D. Local anesthetic systemic toxicity: Prevention, diagnosis and treatment[J]. Anaesthesiol Intens Care, 2014, 43(4): 41-43.
[10]AHRENS J, LEFFLER A. Update on the pharmacology and effects of local anesthetics[J]. Anaesthesist, 2014, 63(5): 376-386. DOI: 10.1007/s00101-014-2302-2.
[11]WOLFE J W, BUTTERWORTH J F. Local anesthetic systemic toxicity: update on mechanisms and treatment[J]. Curr Opin Anaesthesiol, 2011, 24(5): 561-566. DOI: 10.1097/ ACO.0b013e32834a9394.
[12]KLEIN J A. Tumescent technique chronicles. Local anesthesia, liposuction, and beyond[J]. Dermatol Surg, 1995, 21(5): 449-457. DOI: 10.1111/j.15244725.1995.tb00212.x.
[13]KLEIN J A, JESKE D R. Estimated Maximal Safe Dosages of Tumescent Lidocaine[J]. Anesth Analg, 2016, 122(5): 1350-1359. DOI: 10.1213/ANE.0000000000001119.
[14]宋应寒, 陆安清, 马东扬, 等. 不同浓度利多卡因局部浸润麻醉在腹股沟疝修补术中的应用[J]. 中华疝和腹壁外科杂志(电子版), 2013, 7(6): 535-538.  DOI: 10.3877/cma.j.i ssn.1674392X.2013.06.008.
SONG Y H,LU A Q,MA D Y, et al. Applicaton of low concentration of lidocaine for inguinal hernia repair under local infiltration anesthesia[J].Chin J Hernia Abdominal Wall Surg(Electronic Edition),2013, 7(6): 535-538. DOI: 10.3877/ cma.j.issn.1674-392X.2013.06.008.
[15]谢妍妍,宋应寒,马东扬,等. 腹股沟疝日间手术在年龄≥70岁患者中的可行性探讨[J].中华消化外科杂志,2016,15(10):972-977.DOI:10.3760/cma.j.issn.16739752.2016.10.007.
XIE Y Y, SONG Y H, MA D Y, et al. Clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients[J]. Chin J Digest Surg, 2016, 15(10): 972-977. DOI:10.3760/cma.j.issn.1673-9752.2016.10.007.
[16]BROWN D L, RANSOM D M, HALL J A, et al. Regional anesthesia and local anestheticinduced systemic toxicity: seizure frequency and accompanying cardiovascular changes[J]. Anesth Analg, 1995, 81(2): 321-328. DOI:10.1097/00000539-199508000-00020.
[17]TAKAHASHI R, ODA Y, TANAKA K, et al. Epinephrine increases the extracellular lidocaine concentration in the brain: a possible mechanism for increased central nervous system toxicity[J]. Anesthesiology, 2006, 105(5): 984-989. DOI:10.1097/0000054220061100000020.
[18]COVINO B G. Pharmacology of local anaesthetic agents[J]. Br J Anaesth, 1986, 58(7): 701-716. DOI:10.1093/bja/58.7.701.
[19]KLEIN J A. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction[J]. J Dermatol Surg Oncol, 1990, 16(3): 248-263. DOI: 10.1111/ j.15244725.1990.tb03961.x.
[20]刘子嘉, 黄宇光. 术后慢性疼痛的危险因素及发病机制[J]. 国际麻醉学与复苏杂志, 2013, 34(2): 163-166. DOI: 10.3760/cma.j.issn.1673-4378.2013.02.017.
LIU Z J, HUANG Y G. Risk factors and pathogenesis of postoperative chronic pain[J]. Int J Anesthesiol Resusc, 2013, 34(2): 163-166. DOI: 10.3760/cma.j.issn.1673-4378.2013.02.017.
[21]TOKUMURA H, NOMURA R, SAIJO F, et al. Tumescent TAPP: laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas[J]. Surg Today, 2017, 47(1): 52-57. DOI: 10.1007/s00595-0161349-x.

相似文献/References:

[1]李义兵,陈俊,冯怡墨,等.改良平片无张力疝修补术56例报告[J].第三军医大学学报,2004,26(11):0.[doi:10.16016/j.1000-5404.2004.11.039 ]
[2]陈华,靳明林,张毅,等.巨大滑疝1例[J].第三军医大学学报,2002,24(04):0.[doi:10.16016/j.1000-5404.2002.04.014 ]

更新日期/Last Update: 2017-11-13