Falco N, Tutino R, Fontana T, Gullo R, Licari L, Raspanti C, De Marco P, Colli F, Venturelli P, Salamone G, Cocorullo G
G Chir. 2019 May-Jun;40(3):182-187.
Since 1899 outpatient management of surgical patients had been increasing, becoming the best option when possible. In 1988 was described the first experience of outpatient management of proctologic disease. Advances in local anesthesia techniques have improved the outpatient approach to surgical disease, particularly in patients with proctological diseases.
From 2010 to 2016, 1160 patients who needed surgery for proctologic disease have been recruited: 239 hemorrhoidectomies using the variant of Milligan Morgan technique described by Phillips, 45 trans-anal hemorrhoidal DE-arterialization (THD), 315 sphincterotomies, 12 anal polypectomies, 230 loop seton positions, 65 cone-like fistulectomies and 254 fistulotomies for perianal fistulas. In 329 cases, we used the posterior perineal block, 603 local perineal blocks, and 228 tumescent anesthesia.
On a total of 1160 procedure failure rate was of 4.7% (55 cases). Urinary retention (69% 38 cases); bleeding 18% (10 cases), uncontrolled pain 12% of cases (7 cases). The chi-square test demonstrates (p<0.01) that the failure rate of the three types of anesthesia is very different with high statistical significance. The failure rate in patient underwent Posterior Perineal Block was 27/329 cases (8.2%), 8/228 (3.5%) in patients who underwent Tumescent Anesthesia and 20/603 (3.3%) in who underwent Local Perineal Block.
Outpatient protocols represent the most common approach to minor proctologic disease that needs a good local block, with a good analgesic and sedative assistance, the different local block seems to be the same concerning the pain control, but presents some little, not relevant difference concerning urinary retention rate.
自1899年以来，外科患者的门诊管理一直在增加，在可能的情况下成为最佳选择。1988年描述了直肠疾病门诊管理的首次经验。局部麻醉技术的进步改善了外科疾病的门诊治疗方法，特别是在直肠疾病患者中。
2010年至2016年，招募了1160例需要进行直肠疾病手术的患者：采用菲利普斯描述的米利根·摩根技术变体进行239例痔切除术，45例经肛门痔去动脉化（THD），315例括约肌切开术，12例肛门息肉切除术，230例套扎术，65例锥形肛瘘切除术和254例肛周肛瘘瘘管切开术。在329例病例中，我们使用了后会阴阻滞，603例局部会阴阻滞和228例肿胀麻醉。
在总共1160例手术中，失败率为4.7%（55例）。尿潴留（69%，38例）；出血18%（10例），疼痛控制不佳12%（7例）。卡方检验表明（p<0.01），三种麻醉类型的失败率差异很大，具有很高的统计学意义。接受后会阴阻滞的患者失败率为27/329例（8.2%），接受肿胀麻醉的患者为8/228例（3.5%），接受局部会阴阻滞的患者为20/603例（3.3%）。
门诊治疗方案是治疗需要良好局部阻滞的轻度直肠疾病最常用的方法，辅以良好的镇痛和镇静辅助，不同的局部阻滞在疼痛控制方面似乎相同，但在尿潴留率方面存在一些微小的、不相关的差异。
