局部麻醉和蛛网膜下腔联合硬膜外麻醉下行吻合器痔上黏膜环形切除术的对比观察

The contrast of procedure for prolapse and hemorrhoids between the local anesthesia and the combined spinal epidural anesthesia

目的探讨在局部麻醉下行吻合器痔上黏膜环形切除术治疗Ⅲ、Ⅳ度混合痔的临床效果。方法将150例Ⅲ、Ⅳ度混合痔患者随机分组在局部麻醉（局部麻醉组，73例）和蛛网膜下腔联合硬膜外麻醉（腰硬组，77例）下行吻合器痔上黏膜环形切除术，对比观察两组安全性和有效性指标。结果手术后两组患者原有症状均得到满意改善。住院时间、住院费用局部麻醉组与腰硬组分别为（4．8±1．1）d与（6．8±1．1）d、（3980±639）元与（5128±728）元，两组比较差异均有统计学意义（P〈0．05）；术后两组尿潴留发生率分别为9．6％、24．7％，两组比较差异有统计学意义（P〈0．05）；两组术后恢复正常活动时间、疼痛指数、肛门失禁和瘙痒、术后残留皮赘和术后痔脱垂比较差异均无统计学意义（P〉0．05）。结论在局部麻醉下行吻合器痔上黏膜环形切除术安全可行，在缩短住院时间、减少住院费用方面明显优于在蛛网膜下腔联合硬膜外麻醉，术后发生尿潴留几率也明显下降。

Objective rio explore the clinical effect of procedure for prolapse and hemorrhoids （PPH） treating for Ⅲ and Ⅳ degree hemorrhoid under the local anesthesia. Methods One hundred and fifty patients with Ⅲ and Ⅳ degree hemorrhoid were divided into two groups randomly. One group was the local anesthesia group （LA group） which included 73 cases, the other one was the combined spinal epidural anesthesia group （CSE group） which included 77 cases. Compared the safety and emcacy of different procedure. Results The original symptom of the two groups were improved. There was a significant difference in the time of hospitalization time and the hospitalization expense between the two groups （P 〈 0.05）.The LA group was（4.8 ± 1.1）days with（3980 ± 639）yuan, and the CSE group was（6.8 ± 1.1） days with（5128 ± 728）yuan. The rates of two groups of urine retention were 9.6% and 24.7% （P 〈 0.05 ） after the operation respectively, and there were no significant differences in recovery normal activity time, the pain index , copracrasia and pruritus, the bleed, the anal fistula ,the prolapse of hemorrhoid ,the skin tag （P 〉 0.05）. Conclusion . PPH under the local anesthesia is safe, compare to the combined spinal epidural anesthesia,it excels in shortening the hospitalization time and reducing the hospitalization expense , also it can reduce significantly the rate of urine retention after operation.