腹股沟疝修补术后尿潴留影响因素和防治策略

doi:10.3877/cma.j.issn.1674-392X.2023.04.007

腹股沟疝修补术是普外科常见手术方式，其术后尿潴留较为多见，文献报道发生率高达30%，不仅给患者带来痛苦，同时增加了医疗支出、严重影响患者手术满意度。研究发现患者自身因素及围手术期因素均可影响疝修补手术后尿潴留的发生，机制包括尿路阻力增加、排尿相关神经通路中断、逼尿肌损伤等。临床医师了解其影响因素及机制一方面有助于早期识别高危患者进行术前宣教，另一方面通过调整手术时间、麻醉方式、输液量、补片固定方法等可控危险因素可最大限度地降低尿潴留发生率。此外，α-受体阻滞剂、糖皮质激素等药物也可有效预防尿潴留的发生。导尿则是处理术后尿潴留最直接有效的方法。本文对腹股沟疝修补术后尿潴留影响因素和防治策略作一综述，以期为预防及规范化处理疝修补手术术后尿潴留提供思路。

关键词: 疝，腹股沟, 疝修补术, 尿潴留, 影响因素

Inguinal hernia repair (IHR) is a common surgical procedure in general surgery. Postoperative urinary retention (POUR) is a common complication and the incidence is as high as 30% in the literature. It not only brings pain to the patients, but also increases medical expenses and seriously affects the satisfaction of patients. It has been found that patients factors and perioperative factors can significantly affect the occurrence of POUR in IHR surgery. The mechanism of POUR includes urinary obstruction, interruption of micturition related neural pathway, detrusor muscle injury, etc. Understanding of the influencing factors and mechanisms can help clinicians to identify high-risk patients in early stage for preoperative education. On the other hand, the incidence of POUR can be minimized by adjusting the operation time, anesthesia, infusion volume, mesh fixation and other controllable risk factors. In addition, α- receptor blockers, glucocorticoids and other drugs can also effectively prevent POUR. Catheterization is the most direct and effective way to treat POUR. This article reviews the influencing factors and prevention strategies of POUR after IHR, in order to provide ideas for the prevention and standardized treatment POUR of IHR surgery.

Key words: Hernia, inguinal, Herniorrhaphy, Urinary retention, Influencing factors

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