关键词: 腹股沟疝, 嵌顿疝, 腹横肌平面阻滞, 超声引导, Lichtenstein手术

Abstract: The application of ultrasound-guided transversus abdominis plane nerve block (TAP) in adult incarcerated inguinal hernia surgery        LUO Wen，WANG Yong，DUAN Xin，et al. The Central Hospital of Wu Han,Tongji Medical College Huazhong University of Science & Technology，Wuhan 430014，China
Corresponding author：LUO Wen，E-mail：rovine1984@sohu.com.
Abstract    Objective    To investigate the application of ultrasound-guided transversus abdominis plane nerve block (TAP) in adult incarcerated inguinal hernia surgery，and to analyze the superiority and security of TAP anesthesia technology combined with Lichtenstein tension-free hernia repair in surgery of incarcerated hernia patients. Methods  A retrospective analysis of clinical data of 78 patients with incarcerated inguinal hernia admitted to Wuhan Central Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 2015 to January 2021 was launched. All patients were primary incarcerated hernias，and were treated with TAP anesthesia. Emergency Lichtenstein tension-free hernia surgery was made after the hernia ring was released. Results    The 78 patients were successfully operated on. The repair time was 30 to 70 minutes，with an average of (35.2 ± 11.7) min. The postoperative hospital stay was 1 to 7 days，with an average of 3.0 ± 1.0 d. The small intestine and mesentery were found during the operation. There were 40 patients with omentum incarceration，7 patients with colon incarceration，24 patients with omental incarceration，6 patients with preperitoneal fat and peritoneal incarceration，and 1 patient with appendix incarceration. 3 patients appeared with postoperative wound fat liquefaction and scrotal skin ecchymosis occurred in 4 patients. There were no wounds and patch infections. Postoperative delayed bowel perforation，cardio-cerebral vascular accidents，secondary pulmonary infections，hepatic encephalopathy，gastrointestinal bleeding and other severe complications didn’t occur；2 cases had scrotal seroma after the operation. The follow-up time was 1-12 months. All patients were followed up. No recurrence occurred on the surgical side. There were 3 cases of new inguinal hernia on the contralateral side. Conclusion    TAP technology combined with Lichtenstein tension-free hernia repair is an ideal anesthesia method for patients with severe underlying diseases and with higher risks for general anesthesia and continuous epidural anesthesia suffering the treatment of inguinal incarcerated hernia. It has simple operation，wide indications and few complications，which deserves further promotion.

Key words: hernia repair, incarcerated hernia, transversus abdominis plane（TAP）, ultrasound guidance, hernia