Comparison of the Surgical Results of Hemorrhoidectomy under Intravenous General Anesthesia and Spinal Anesthesia

比較痔瘡切除術在靜脈全身麻醉與脊椎麻醉之下手術結果

陳莊偉(Chuang-Wei Chen) ； 陳宗明(Chung-Ming Chen) ； 蕭光宏(Koung-Hong Hsiao)

《中華民國大腸直腸外科醫學會雜誌》 25卷3期 (2014/09) Pp. 85-91

https://doi.org/10.6312/SCRSTW.2014.25(3).10312

摘要

目的　這個研究的目的是要評估兩種常使用於痔瘡切除手術的麻醉方式，分析其優劣及手術結果之間有無差異。方法　我們前瞻性地收集連續八十一位診斷為第三、四度脫垂痔瘡的病患在我們醫院接受組織凝集器（LigaSure）痔瘡切除手術的資料。這些病人中，四十位接受靜脈全身麻醉合併局部肛門注射麻醉（Group 1），四十一位接受脊椎麻醉（Group 2）。我們比較這兩組病人之基本資料、手術時間、手術室內所需花費的時間、術後疼痛指數、止痛劑使用量、併發症、住院天數、手術結果及病人滿意度。結果　所有病人均能在趴臥傑克式剪刀（prone jackknife position）的姿勢下完成痔瘡切除手術且沒有術中麻醉相關併發症。這兩組病患在年齡（age 44.1 vs. 42.6 years, p = 0.587）、性別（male:female;19/21 vs. 20/21, p = 0.908）、ASA分級（33 ASA I and 7 ASA II in group 1 vs. 33 ASA I and 8 ASA II in group 2, p = 0.816）、術前血色素值（13.7 vs. 13.9 g/dl, p = 0.561）、手術時間（23.8 vs. 22.7 min, p = 0.642）、平均住院天數（2.2 vs. 2.3 days, p = 0.576）、平均術後第一天的疼痛指數（4.5 vs. 4.6, p = 0.729）、平均術後止痛劑的使用劑量（1.4 vs. 1.5 times per person, p = 0.743）、早期及晚期手術併發症（3/40 in group 1 vs. 5/41 in group 2, p = 0.712）、平均術後追蹤時間（6.9 vs. 7.1 months, p = 0.566）及病患對整體手術的滿意度（satisfied or very satisfied: 34/40 in group 1 vs. 33/41 in group 2, p = 0.770）上均沒有統計上的顯著差別。然而，Group 2的病患平均在手術室內所需花費的時間明顯比Group 1病患來的長（45.5 vs. 60.1 min, respectively, p ＜ 0.05）。在追蹤期間內，兩組病人均無排便失禁、肛門狹窄或復發症狀。結論　這兩種麻醉方式對於痔瘡切除術均是安全有效的，並且在手術結果、止痛劑使用量、術後併發症及病患滿意度上均無顯著差別。然而，病患於脊椎麻醉下進行痔瘡手術比在靜脈全身麻醉下需要明顯較長的時間於手術室內。

關鍵字

痔瘡切除術 ； 靜脈全身麻醉 ； 脊椎麻醉 ； 併發症 ； 滿意度

並列摘要

Background. The purpose of this study is to evaluate the pros and cons of the two common anesthetic methods used for hemorrhoidectomy. Methods. We prospectively collected a database of 81 consecutive patients whose symptomatic hemorrhoids were managed by LigaSure hemorrhoidectomy at our hospital. Among these patients, 40 received intravenous general anesthesia with perianal anesthetic infiltration (group 1) and 41 patients received spinal anesthesia (group 2). The groups were compared with respect to demographic data, operative time, total time in the operating room, postoperative pain score, narcotic consumption, complications, length of hospital stay, operative outcomes, and satisfaction level. Results. All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic or anesthetic-associated complications. There was no significant difference between the groups with respect to patient age, gender, ASA grade, preoperative hemoglobin level, operative time, duration of hospital stay, pain score of the first postoperative day, postoperative narcotic consumption, early or late complications, duration of follow-up, and patient satisfaction level. However, the mean time spent in the operating room was significant longer in group 2 than in group 1 (45.5 vs. 60.1 min, respectively, p ＜ 0.05). At the completion of follow-up, all patients in both groups were fully continent and no instances of anal stricture or recurrent symptoms occurred. Conclusion. Both anesthetic methods are safe and effective for hemorrhoidectomy without significant difference in operative outcomes, analgesic requirements, complications, and patient satisfaction. However, spinal anesthesia is associated with a longer time in the operating room.

並列關鍵字

Hemorrhoidectomy ； Intravenous general anesthesia ； Spinal anesthesia ； Complication ； Satisfaction

參考文獻

1. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35:477-81.

2. Holzheimer RG. Hemorrhoidectomy: indications and risks. Eur J Med Res 2004;9:18-36.

3. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities: a meta-analysis. Dis Colon Rectum 1995;38:687-94.

4. Pfenninger JL. Modern treatments for internal hemorrhoids. BMJ 1997;314:1211-2.

5. Kisli E, Agargun MY, Tekin M, Selvi Y, Karaayvaz M. Effects of spinal anesthesia and laryngeal mask anesthesia on mood states during hemorrhoidectomy. Adv Ther. 2007;24:171-7.