输尿管双J管在熟练医师腹腔镜下宫颈癌根治术中应用的探讨

目的:探讨术前放置输尿管双J管在腹腔镜下宫颈癌根治术中应用的利弊。方法:回顾性分析2017年1—12月在中国人民解放军总医院行腹腔镜下宫颈癌根治术的初治患者共139例,根据是否放置双J管分为放管组(n=75)和未放管组(n=64)。比较2组一般资料、术中情况和术后并发症发生率。结果:放管组手术时间小于未放管组,差异有统计学意义(P<0.05)。2组术中出血量和淋巴结清扫数差异无统计学意义(均P>0.05)。放管组患者术后泌尿系统感染发生率高于未放管组,差异有统计学意义(P<0.05)。2组术后泌尿系统损伤和发热发生率差异无统计学意义(均P>0.05)。放管时间短期组泌尿系统感染发生率(20.0%)小于长期组(42.5%),差异有统计学意义(χ~2=4.343,P=0.037);短期组肾盂扩张发生率(8.6%)虽小于长期组(12.5%),但差异无统计学意义(P=0.716)。结论:对于熟练掌握腹腔镜下宫颈癌根治术的医师,术前预置输尿管双J管对手术操作影响不大。术前放置输尿管双J管可减少手术时间,但对术中出血量和淋巴结清扫数影响不大,反而增加术后感染风险。若无明确泌尿系统损伤,双J管可于术后2～3周与尿管一起拔除。

Application of Double-J Ureteral Tube in Laparoscopic Radical Surgery of Cervical Cancer

Objective：To determine the advantages and disadvantages of preoperative placement of ureteral double J tubes in laparoscopic radical surgery for cervical cancer. Methods: A retrospective analysis of 139 cases of laparoscopic radical resection of cervical cancer in the General Hospital of the People′s Liberation Army from January to December 2017, according to whether the double J tube was placed into the drainage group (n=75) or not (control group，n=64). Compare the general information, intraoperative condition and postoperative complication rate of the two groups. Results: The operation time of the drainage group was shorter than that of the control group, and the difference was statistically significant (P＜0.05). There was no significant difference in the amount of intraoperative blood loss and lymph node dissection between two groups (P＞0.05). The incidence of postoperative urinary tract infection in the drainage group was higher than that of the control group (P＜0.05). There was no significant difference in the incidence of postoperative urinary system injury and fever between two groups (all P＞0.05). The incidence of urinary tract infection in the short-term group (20.0%) was lower than that of the long-term group (42.5%), and the difference was statistically significant (χ2=4.343, P=0.037); the incidence of pyelectasis in the short-term group (8.6%) was less than the long-term group (12.5%), but the difference was not statistically significant (P=0.716). Conclusions: Placement of ureteral double J tube before surgery has little effect on surgery for skilled doctors. Double J tube can reduce the operation time, but has little effect on intraoperative bleeding and lymph node dissection, and increases the risk of postoperative infection. If there isn′t urinary system damage, it can be removed together with the urinary catheter 2 or 3 weeks after surgery.