微创医学

目的探讨腹股沟疝经腹腹腔镜腹膜前补片修补术（TAPP）术中封闭对腹股沟疝硬化剂治疗失败后局部疼痛的影响。方法回顾性分析硬化剂治疗失败患者的临床资料，根据处理方式的不同，将硬化剂注射治疗半年以上，出现疝复发的80例患者分为观察组和对照组，每组40例。对照组常规行TAPP治疗，观察组在术中进行腹膜前间隙封闭治疗。对比两组术后1周、1个月、3个月及6个月视觉模拟评分（VAS），统计分析两组术后急、慢性疼痛的发生率。结果所有患者无术中中转开放手术。观察组与对照组术后并发症发生率（10.0% vs. 15.0%）比较，差异无统计学意义（P＞0.05）。两组麻醉时间、手术时间、气腹时间和住院时间比较，差异无统计学意义（P＞0.05）。对照组术后急性局部疼痛7例，慢性疼痛11例；观察组术后急性局部疼痛2例，慢性疼痛5例。两组急、慢性疼痛发生率比较，差异无统计学意义（P＞0.05）。观察组术后1周、1个月、3个月及6个月的VAS 评分均显著低于对照组，差异有统计学意义（P＜0.05）。结论在TAPP术中将甲钴胺、曲安奈德与利多卡因注射液混合经腹壁注入腹膜前间隙，可有效减少硬化剂治疗失败腔镜疝修补术后急慢性疼痛的发生。

ObjectiveTo investigate the effect of block therapy during laparoscopic transabdominal preperitoneal herniorrhaphy on local pain in patients with inguinal hernia after failure of sclerotherapy. MethodsClinical data of the patients with hernia who failed in sclerotherapy 6 months or longer ago were retrospectively analyzed. The patients were divided into observation group and control group, with 40 cases in each group. The control group underwent conventional laparoscopic transabdominal preperitoneal herniorrhaphy, and the observation group also received the block therapy in the preperitoneal space. The visual analogue scale (VAS) scores were compared between the two groups at 1 week, 1 month, 3 months and 6 months after surgery. The incident rates of postoperative acute and chronic pain were compared between the two groups. ResultsNo conversion to open laparotomy occurred in any cases. There was no significant difference in the incident rate of postoperative complication between the observation group and control group(10.0% vs. 15.0%, P＞0.05). There were no significant differences in the anesthesia duration, operation duration, pneumoperitoneum duration and hospital stay between the two groups（P＞0.05）. Postopeartive acute local pain and chronic pain were observed in 7 cases and 11 cases in the control group respectively. Postopeartive acute local pain and chronic pain were observed in 2 cases and 5 cases in the observation group respectively. There was no significant difference in the incident rate of postoperative acute and chronic pain between the two groups（P＞0.05）. At 1 week, 1 month, 3 months and 6 months after surgery, the VAS scores of the observation group were significantly lower than those of the control group (P＜0.05). ConclusionDuring laparoscopic transabdominal preperitoneal herniorrhaphy, injection into the preperitoneal space with the mixture of mecobalamin, triamcinolone acetonide and lidocaine can effectively reduce the occurrence of postoperative acute and chronic pain in the patients failed in sclerotherapy.