阴囊手术的麻醉方式

图21-1　防止感染扩散的解剖屏障(Modified from Kavoussi PK,Costabile RA.Disorders of scrotal contents:orchitis,epididymitis,testicular torsion,torsion of the appendages,and Fournier's gangrene.ln:Chapple CR,Steers WD,editors.Practical urology:essential principles and practice.London:Springer-Verlag;2011.)

图21-2　防止感染扩散的解剖屏障的矢状观(Modified from Kavoussi PK,Costabile RA.Disorders of scrotal contents:orchitis,epididymitis,testicular torsion,torsion of the appendages,and Fournier’s gangrene.ln:Chapple CR,Steers WD,editors.Practical urology:essential principles and practice.London:Springer-Verlag;2011.)

阴囊手术的有效麻醉方式有镇静或无镇静下的局部麻醉、椎管内麻醉及全身麻醉。局部注射不含肾上腺素的0.5%的利多卡因的精索内阻滞麻醉,是一种简单、经济有效的麻醉方式,可用于门诊阴囊手术。区域性精索阻滞麻醉通常用于无预先给药且患者镇痛满意的情况下 (Wakefield and Elewa,1994;Magoha,1998)。精索阻滞麻醉可用于巨大鞘膜积液患者,首先在鞘膜积液经皮引流时进行麻醉阻滞,然后行鞘膜切除术(Reale et al,1998)。在门诊阴囊手术中,使用咪达唑仑镇静配合术后镇静的局部阻滞麻醉,可以取得很高的患者满意度(Birch and Miller,1994)。