硬脊椎腦膜外腔麻醉法不會增加門診痔瘡切除術後尿液滯留和解尿困難的機率

Epidural Anesthesia Does Not Increase the Incidences of Urinary Retention and Hesitancy in Micturition after Ambulatory Hemorrhoidectomy

背景：本研究是著眼於門診痔瘡切除術，是否因為不同的麻醉方法，而影響術後尿液滯留和解尿困難的機率。方法：針對128位ASA分級1或2，欲接受門診痔瘡切除術的病患，隨機分成二組。第一組採用硬脊椎腦膜外腔麻醉，而第二組則使用局部麻醉。每位病患在手術中均給予200 ± 2 ml/kg/h的靜脈林格氏乳酸輸液。術後每位病患均被要求能自行解尿後才能返家。術後24小時再利用 電話訪談來統計術後尿液滯留和解尿困難的機率。結果：二組在尿液滯留和解尿困難出現的機率並沒有統計上的差異。50歲以上的病患發生解尿困難的機率，和其他年齡層有顯著差異。男性解尿困難的比例(31.3％)大於女性(15.6％)，但沒有統計上的差異(P = 0.0585)。結論：使用硬脊椎腦膜外腔麻醉做為門診痔瘡切除術的麻醉法，若在術中節制輸液量，並在離院前讓病患自行解尿，則病患在返家後並不會增加尿液滯留和解尿困難的機率。

Background: This randomized, prospective study was designed to evaluate the role of various anesthesias in postoperative urinary retention and hesitancy in micturition in patients receiving hemorrhoidectomy on ambulatory basis. Methods: In a randomized order, 128 ambulatory patients, ASA physical status I or II, were divided into two groups to receive hemorrhoidectomy under epidural or local anesthesia. In all patients, the intraoperative intravenous fluid given was limited to 200 ml ± 2 ml/kg/h of Ringer's lactate solution. Patients were requested to void urine voluntarily before discharge. The incidences of postoperative urinary retention and hesitancy in micturition were evaluated by telephone interview 24 hours after surgery. Results: Neither the incidence of urinary retention, nor the incidence of hesitancy in micturition was significantly different between the two groups. Patients with age over 50 had a significantly higher incidence of hesitancy in micturition than younger patients. The incidence of hesitancy in micturition seemed higher in male patients (31.3%) than that in females (15.6%), but the difference was not statistically different (P = 0.0585). Conclusions: With judicious intraopertive fluid restriction and voluntary voiding before discharge, epidural anesthesia does not increase the incidence of postoperative urinary retention or hesitancy in micturition following ambulatory hemorrhoidectomy.