早期拔除尿管对结直肠手术患者泌尿系统并发症影响的Meta分析

目的系统评价早期拔除尿管对结直肠手术患者泌尿系统并发症的影响。方法计算机检索Pubmed、EMBASE、OVID、EBSCO、Cochrane Library、中国知网、万方数据库、维普中文期刊数据库、中国生物医学文献数据库中关于结直肠手术术后早期拔除尿管的随机对照试验或临床对照试验,使用Revman5.3软件对数据进行统计分析。结果最终纳入6项随机对照试验,1项临床对照试验,共803例患者。Meta分析结果显示,术后≤2d与术后3d拔除尿管的尿路感染发生率、急性尿潴留发生率比较,差异无统计学意义[OR=0.27,95%CI(0.05,1.44),P0.05;OR=1.68,95%CI(0.72,3.91),P0.05]。术后≤2d拔除尿管的尿路感染发生率显著低于术后5d[OR=0.21,95%CI(0.09,0.47),P0.01],术后≤2d拔除尿管的急性尿潴留发生率高于术后5d[OR=3.30,95%CI(1.90,5.74),P0.01]和硬膜外镇痛停止后[OR=3.94,95%CI(1.26,12.28),P0.05]。结论术后早期(术后≤2d)拔除尿管对降低尿路感染发生率有明显优势,但可能增加拔尿管后急性尿潴留的发生风险。     

耻骨上置尿管在低位结直肠手术中优越性的证据

膀胱内置尿管是低位结直肠手术前的常规操作 ,既可监尿量 ,又能防止术后尿潴留。经尿道置尿管是目前常用的方法 ,但在妇科手术 ,耻骨上置尿管较常应用 ,有报道此种方法较传统方法有明显优越性。　　本文总结有关耻骨上置尿管 ( SPC)与经尿道置尿管 ( TUC)研究的文献 ,从尿路感染、尿潴留、对尿管的耐受度、疼痛以及病人对两种导尿术的比较选择等方面对二者作了比较。　　结果 :有关二者的 5组前瞻性研究中 ,有 3组报道 TUC尿路感染发病率明显高于 SPC;1组报道TUC出现尿频较 SPC高 ,另一组报道二者无明显差异。拔除导尿管后 ,尿潴留…     

胸腔镜肺切除术围术期不放置导尿管的可行性研究

目的探讨胸腔镜肺切除术围术期不放置导尿管的可行性。方法选取2018年6～12月胸腔镜肺切除术220例,随机分为无尿管留置组及尿管留置组各110例。比较2组术后尿路感染、尿潴留发生率,术后舒适度(Kolcaba舒适状况量表)、首次下床时间、术后住院时间及住院费用;比较男性患者术后国际前列腺症状评分(IPSS)严重程度。结果与尿管留置组相比,无尿管留置组术后尿路感染发生率低[21. 8%(24/110) vs. 34. 5%(38/110),χ2=4. 402,P=0. 036],Kolcaba舒适状况量表的生理、心理精神、社会文化以及环境等舒适度得分高,首次下床早,术后住院时间短,住院费用低,均有统计学差异(P 0. 05),2组尿潴留发生率差异无显著性(P 0. 05)。无尿管留置组男性患者术后24 h IPSS评分轻、中、重度分别为33、28、7例,尿管留置组分别为20例、27例、22例,差异有显著性(Z=-2. 469,P=0. 014)。结论胸腔镜肺切除术不留置尿管能够降低尿路感染发生率,提高术后患者舒适度,缩短首次下床时间及住院时间,降低术后IPSS评分严重程度,促进患者快速康复。     

肺叶切除术后患者无尿管留置的前瞻性队列研究

目的探讨肺叶切除术后无尿管留置的临床应用效果和不足。方法前瞻性纳入2014年4~12月在四川大学华西医院胸外科单个医疗组行肺癌肺叶切除术的患者100例。将患者分为两组:无尿管留置组,麻醉后置入尿管和术后清醒前拔除导尿管,50例,男女各25例,年龄(53.94±10.91)岁;尿管留置组,麻醉后置入尿管和术后24~72 h拔除尿管,50例,男22例、女28例,年龄(50.62±12.31)岁。比较两组患者康复情况。结果两组患者尿潴留(P=0.433)和尿路感染发生率(P=0.050)差异均无统计学意义。无尿管留置组患者术后舒适度0度高于尿管留置组,且差异有统计学意义(P=0.002)。而尿管留置组有尿道症状(Ⅰ度、Ⅱ度和Ⅲ度)高于无尿管留置组(P=0.023),且差异有统计学意义。无尿管留置组术后平均住院时间短于尿管留置组(P=0.004)。前列腺增生症是肺部术后发生尿潴留的高危因素(P=0.056)。结论肺部手术患者术后无尿管留置未增加尿潴留,且能提高患者术后舒适度和快速康复。     

不同引流袋预防结直肠癌术后患者尿路感染效果比较

目的比较普通引流袋、康维抗反流引流袋和防逆流引流袋预防结直肠癌患者术后尿路感染的效果。方法将147例结直肠癌患者随机分为A组49例、B组50例、C组48例,均使用相同的一次性导尿包进行留置导尿,留置尿管期间进行常规留置导尿护理。A组使用普通引流袋,每周更换2次;B组使用康维抗反流引流袋,每周更换1次;C组使用防逆流引流袋,每周更换1次。结果术后第1、3、5天三组尿路感染发生率比较,差异无统计学意义(均P>0.05),术后第7天A组尿路感染发生率显著高于B组和C组(均P<0.0125)。结论康维抗反流引流袋和防逆流引流袋有利于减少留置尿管1周及以上的结直肠癌术后患者尿路感染。     

荷包缝合钳代替直线型吻合器行直肠癌低位保肛术

目的 探讨经济、实用、安全的直肠癌低位保肛手术方法。方法 对245例中低位直肠癌患者按全直肠系膜切除术(TME)要求切除直肠，荷包缝合钳封闭直肠残端，管型直肠吻合器行低位保肛术。结果 低位前切除106例，超低位前切除117例，结肠肛管吻合术22例。本组切缘均无肿瘤残留。术后出现吻合口瘘10例(4．1％)，均经横结肠造瘘后痊愈；尿潴留16例(6．5％)；手术死亡1例(0．4％)。结论 用荷包缝合钳代替直线型吻合器行直肠癌低位保肛术安全、简便、经济。     

初次髋膝关节置换术中不留置尿管的可行性和安全性研究

目的探讨单侧初次髋或膝关节置换术中不常规留置尿管的可行性及安全性,以减少不必要的导尿,提高患者就医舒适度和满意度。 方法本文回顾性分析中日友好医院骨关节外科2015年11月至2016年10月期间109例无明显尿潴留高危因素、无术前尿路感染、无尿路刺激征及重度肝肾功能不全、且接受单侧初次髋或膝关节置换术、术中不留置尿管(NIC)患者的资料。根据配对条件,与同期行常规术前留置尿管(IC)的单侧初次髋或膝关节置换患者按照1 ∶1进行配对研究,应用SPSS 19.0统计学软件对正态分布计量资料采用配对t检验,非正态分布计量资料采用Wilcoxon符号秩和检验,计数资料采用χ²检验分析比较两组患者术后的尿潴留、二次尿潴留、尿管相关膀胱不适、尿路刺激症、尿路感染、不良事件发生率,以及术后住院时间及患者满意度,分析并评价不留置尿管在单侧初次髋、膝关节置换术中的可行性及安全性。 结果两组患者术后尿潴留、二次尿潴留、尿路感染发生率比较,差异无统计学意义(P>0.05),NIC组术后尿管相关膀胱不适、尿路刺激征、不良事件发生率及术后住院时间均明显低于IC组,而患者满意度高于IC组,两组比较差异有统计学意义(χ²＝10.844,P<0.05),单侧初次髋或膝关节置换术中不必要的导尿高达81.7%。 结论初次髋或膝关节置换术中不常规留置尿管安全可靠,能有效减少尿管相关膀胱不适、尿路刺激征及不良事件的发生,同时可缩短术后住院时间,提高患者早期满意度。     

腹腔镜下全直肠系膜加经内外括约肌间切除用于超低位直肠癌保肛手术

目的:探讨腹腔镜下全直肠系膜加经内外括约肌间切除术治疗超低位直肠癌的可行性及优势。方法:回顾分析2004年11月至2005年11月7例腹腔镜下全直肠系膜加经内外括约肌间切除治疗超低位直肠癌的临床资料。结果:本组7例术中出血量30~80m l,手术时间3.5~5h,无术中死亡病例,术后持续胃肠减压24h,术后24~48h开始饮食,术后3d拔除尿管下床活动,术后1~2d开始排便。术后住院7~10d。随访3~6个月,无局部复发。结论:腹腔镜下按全直肠系膜切除术(TME)要求游离直肠至盆底耻骨直肠肌水平,经肛门于齿状线水平切断直肠,再经肛门手工行结肠-肛管吻合的方法治疗超低位直肠癌,能够保证完整切除直肠系膜,术中减少出血,住院天数缩短,在降低手术难度、提高保肛率等方面有其优势。患者对本术式的耐受性较好。     

双向腔静脉-肺动脉吻合术的手术配合

目的 探讨0．5％甲硝唑、庆太霉素加入0．9％氯化钠溶液膀胱冲洗预防宫颈癌术后留置尿管感染的临床效果。方法 宫颈癌（Ⅰb～Ⅱa期）根治术后留置尿管患者97例，随机分为观察组（49例）和对照组（48例），观察组术后用0．5％碘伏棉球会阴擦洗。2次／d，并于第5天开始每天上午予0．5％甲硝唑0.5g、下午予庆大霉素16万U膀胱冲洗；对照组术后用0．1％苯扎溴铵棉球会阴擦洗，2次／d，并于第5天开始予0．02％呋喃西林250ml膀胱冲洗，2次／d。观察两组惠者置尿管后3、7、10d中段尿培养细菌阳性率。结果 观察组置尿管后3、7、10d尿路感染率显著低于对照组（P〈0．05。P〈0．01）。结论 甲硝唑与庆大霉素膀胱冲洗可以有效预防或减少宫颈癌根治术后留置尿管患者尿路感染的发生。     

腹腔镜辅助直肠全系膜切除术治疗低位直肠癌76例回顾性分析

目的　探讨腹腔镜辅助直肠全系膜切除术治疗低位直肠癌的可行性及临床疗效。方法　选取 1 998年 2月～ 2 0 0 3年 6月本院行腹腔镜直肠全系膜切除术的低位或超低位直肠癌病人 ,收集手术、术后病理学结果及术后并发症和恢复情况的临床资料 ,进行分析和讨论。结果　共有 76例接受腹腔镜直肠全系膜切除术。平均手术时间为 1 78.6± 4 9.9min(90～ 35 0min) ,术中平均出血量为 77.4ml(1 0～ 6 0 0ml) ,术后平均住院天数为 1 7.7± 1 2 .0d(6～ 6 7d) ,肠道功能恢复的时间平均为2 .8d。肿块距下切端平均为 3.35 2± 1 .0 6 2cm(2 .0～ 5 .0cm )。术后并发症发生率为 1 8.4 %。无手术死亡率。中转开腹手术 7例 (9.2 1 % )。总保肛率为 6 3.1 6 %。结论　腹腔镜直肠全系膜切除术能够达到和符合TME的原则 ,治疗低位、超低位直肠癌是可行的     

Optimal duration of urinary drainage after rectal resection: a randomized controlled trial

BACKGROUND: Voiding dysfunction is frequently observed after rectal resection and justifies urinary drainage. However, there is no agreement about the optimal duration of this postoperative drainage. The aim of this controlled trial was to compare 1 versus 5 days of transurethral catheterization after rectal resection, with special reference to urinary tract infection and bladder retention. METHODS: One hundred twenty-six patients undergoing rectal resection were included in a prospective randomized study designed to compare the results for patients undergoing 1 day of transurethral catheterization after rectal resection (1-day group) with those for patients undergoing 5 days' catheterization (5-day group). RESULTS: Patients were randomly assigned to the 1-day and 5-day groups (n = 64 and 62, respectively). Clinical findings and surgical procedures were comparable in both groups. Acute urinary retention occurred in 16 patients (25%) in the 1-day group versus 6 (10%) in the 5-day group (P < .05). Urinary tract infection was observed in 13 of 64 patients (20%) in the 1-day group versus 26 of 62 (42%) in the 5-day group (P < .01). Multivariate analysis revealed that after 1 day of catheterization carcinoma of the low rectum and lymph node metastasis were significant risk factors for acute urinary retention (P < .05 for both factors). After selection of patients without low rectum carcinoma, the acute urinary retention rate was comparable in both groups (14% in the 1-day group versus 7% in the 5-day group), but the urinary tract infection rate was significantly lower in the 1-day group versus the 5-day group (14% vs 40, P < .01). CONCLUSIONS: Our controlled study showed that after rectal resection 1 day of urinary drainage can be recommended for most patients. Five-day drainage should be reserved for patients with low rectal carcinoma.     

Comparison of 1 and 3 days' transurethral Foley catheterization after retropubic incontinence surgery

This prospective study was done to see if reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary tract infections without an increase in voiding problems. Ninety-one women undergoing retropubic surgery for stress urinary incontinence (Burch or Marshall-Marchetti-Krantz) were randomized to either 1 or 3 days' catheterization. Antibiotics were not used. Infection was diagnosed in 9 (20.0%) patients in the 1-day group and in 16 (34.8%) in the 3-day group. Delayed voiding occurred in 13 (28.9%) and 10 (21.7%) patients, respectively, and 5 (11.1%) and 3 (6.5%), respectively, received a new catheter. The differences do not reach statistical significance. Therefore, catheter time may safely be reduced to 1 day. This may lead to fewer infections but also somewhat more voiding problems. If a transurethral catheter is to be used, on balance the two regimens are equivalent.Editorial Comment: The investigators present a simple and clearly defined study on postoperative voiding management, specifically comparing 1 and 3 day's transurethral Foley catheterization after retropubic surgery. The study is limited by insufficient numbers and the possibility of a type II error in comparing such a small difference in length of Foley use (1 versus 3 days), in terms of the incidence of urinary tract infection or voiding dysfunction. In spite of this limitation, the large number of surgeons utilizing transurethral Foley catheterization following retropubic procedures should find this study of interest, as should those who practise in a managed care environment. Removal of the Foley catheter on postoperative day 1 appears to be a viable alternative, as long as adequate bladder emptying is confirmed.     

The effect of suprapubic catheterization versus transurethral catheterization after abdominal surgery on urinary tract infection: a randomized controlled trial

BACKGROUND/AIM: Transurethral catheterization is generally associated with a higher incidence of urinary tract infections than suprapubic catheterization; however, suprapubic catheterization is associated with other disadvantages such as higher costs and a more difficult technique, and at the moment there is no consensus about the use of both catheter systems. Therefore, a prospective randomized study was performed to investigate the effects of suprapubic catheterization and transurethral catheterization in patients undergoing surgery on the incidence of urinary tract infections and patient satisfaction. METHODS: Patients who underwent an elective laparotomy were randomized and received a suprapubic or transurethral catheter. The primary end point was urinary tract infection. Other parameters of urinary tract infection, as well as duration of catheterization, hospital stay, and number of recatheterizations and of relaparotomies were monitored. Treatment 'per protocol' was also analyzed after exclusion of patients receiving another catheter than randomized for. Patients were asked for their satisfaction with the catheters and complaints during and after catheterization. RESULTS: 165 patients were eligible, of whom 19 patients had to be excluded. 75 patients were allocated to receive the suprapubic catheter and 71 the transurethral catheter. There was no difference in the incidence of a urinary tract infection between the suprapubic group (n = 9/75; 12%) and the transurethral group (n = 8/71; 11%). Most patients (6/9) who developed a urinary tract infection in the suprapubic group, however, underwent recatheterization because of postoperative complications/sepsis and relaparotomy. The incidence of urinary tract infections in patients who received a suprapubic catheter and not a transurethral catheter was 3/59 (5%). The patients did not differ with respect to satisfaction and complaints. Being a men, recatheterization and duration of catheterization are risk factors. CONCLUSIONS: The incidence of a urinary tract infection between a suprapubic catheter and a transurethral catheter in patients undergoing major surgery was not different. A potential advantage of the suprapubic catheter (reduction of urinary tract infections) is probably partly negated, because transurethral catheters were used if recatheterization was indicated during the postoperative stay or due to complications.     

Postoperative urinary outcomes in catheterized and non-catheterized patients undergoing laparoscopic-assisted vaginal hysterectomy—a randomized controlled trial

The objective of this study is to assess the impact of bladder catheterization on the incidence of postoperative urinary tract infection (UTI) and urinary retention (PUR) following laparoscopic-assisted vaginal hysterectomy (LAVH). One hundred fifty patients undergoing LAVH were randomly assigned to no catheter use, 1-day, and 2-day catheter groups. The relationship between preoperative, intraoperative, and postoperative factors and the rates of UTI and PUR were determined. The incidences of UTI and PUR were 9.3% and 18.7%, respectively. The highest rate of UTI occurred in the 2-day catheter group; the highest rate of PUR occurred in no-catheter-use group. Multivariable logistical regression showed the duration of catheterization was the single predictor of UTI; duration of catheterization and diabetes mellitus were predictors for PUR. While short-term indwelling catheterization resulted in decreased rate of PUR, UTI rate increased among patients undergoing LAVH. Nonetheless, most patients resumed normal urination shortly after surgery.     

UROLOGICAL COMPLICATIONS FOLLOWING ABDOMINOPERINEAL EXCISION OF THE RECTUM FOR CARCINOMA

A retrospective study was made of 122 patients who had an abdominoperineal excision (APE) of the rectum for carcinoma at Concord Hospital between 1971 and 1979. Fifty-two percent of patients suffered one or more significant urological complications. These included urinary tract infection (32%), operative trauma to the urinary tract (8.5%) and temporary or permanent bladder dysfunction in 35% of patients. Acute urinary retention, when temporary, was managed by simple measures. Chronic retention, incontinence and some episodes of acute retention were due to a neurogenic bladder. These patients were difficult to treat. It is recommended that urodynamic studies be used to assess these patients who develop a neurogenic bladder before any treatment is instituted. This is relevant especially in those patients in whom a transurethral resection of either the bladder neck or prostate is contemplated.     

芒针对脊髓损伤后尿潴留患者的尿动力学影响

目的:探索芒针在治疗脊髓损伤后尿潴留方面的临床意义。方法:2016年1月至2018年6月收治60例脊髓损伤后尿潴留的患者,分为芒针组和毫针组,每组30例,治疗穴位选取秩边和水道。芒针组男23例,女7例,年龄(52±9)岁,治疗予以芒针偶刺双侧穴位,并接电针仪30 min,频率3 Hz,治疗30 min;毫针组男24例,女6例,年龄(56±10)岁,治疗予毫针针刺双侧穴位后,留针30 min;两组的治疗频率都是隔日1次,在治疗2个月后通过分析两组患者达到平衡膀胱的时间、排尿日记、尿动力学指标和尿路感染情况等指标,发掘芒针在治疗该疾病的临床意义。结果:(1)平衡膀胱达到的时间:芒针组(39.5±1.2) d,毫针组(46.5±2.1) d;两组达到平衡膀胱的时间比较差异有统计学意义(P0.05)。(2)两组患者的排尿日记比较,通过组内比较,两组患者治疗后的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量优于治疗前(P0.05);通过组间比较,在治疗后芒针组患者的每日导尿次数、每次导尿量、每日排尿次数、每次排尿量等指标的改善优于毫针组(P0.05)。(3)两组患者的尿路感染改善情况比较:两组患者治疗后尿路感染情况均改善,芒针组的尿路感染改善率优于毫针组(P0.05)。(4)两组患者尿动力学指标的比较:通过组内比较,两组患者治疗后的膀胱容量(VH2O),膀胱压力(pressure vesical,Pves),逼尿肌压力(pressure detrusor,Pdet),平均尿流速(Qave),最大尿流速(Qmax),膀胱顺应性(bladder compliance,BC)等优于治疗前(P0.05);通过组间比较,在治疗后芒针组患者的VH_2O、Pves、Pdet、Qave、Qmax、BC等指标的改善优于毫针组(P0.05)。结论:芒针在改善脊髓损伤后尿潴留患者的排尿状况、尿路感染和尿动力学方面要优于毫针针刺,对提高脊髓损伤后尿潴留患者生活质量具有积极意义,值得在临床上推广应用。     

Transurethral plasmakinetic resection of the prostate is a reliable minimal invasive technique for benign prostate hyperplasia: a meta-analysis of randomized controlled trials

To evaluate the efficacy and safety of plasmakinetic resection of the prostate (PKRP) versus transurethral resection of the prostate (TURP) for the treatment of patients with benign prostate hyperplasia (BPH), a meta-analysis of randomized controlled trials was carried out. We searched PubMed, Embase, Web of Science and the Cochrane Library. The pooled estimates of maximum flow rate, International Prostate Symptom Score, operation time, catheterization time, irrigated volume, hospital stay, transurethral resection syndrome, transfusion, clot retention, urinary retention and urinary stricture were assessed. There was no notable difference in International Prostate Symptom Score between TURP and PKRP groups during the 1-month, 3 months, 6 months and 12 months follow-up period, while the pooled Q_max at 1-month favored PKRP group. PKRP group was related to a lower risk rate of transurethral resection syndrome, transfusion and clot retention, and the catheterization time and operation time were also shorter than that of TURP. The irrigated volume, length of hospital stay, urinary retention and urinary stricture rate were similar between groups. In conclusion, our study suggests that the PKRP is a reliable minimal invasive technique and may anticipatorily prove to be an alternative electrosurgical procedure for the treatment of BPH.     

Urinary tract infections and bacteriuria after gynecological surgery: Experience with 24-hour foley catheterization

The risks of urinary tract infection (UTI) and asymptomatic bacteriuria (AB) associated with short-term catheterization have not yet been established. A prospective observational study was carried out to determine the rates of UTI and AB when transurethral Foley catheterization was used for 24 hours. The study population was 193 women undergoing routine gynecologic surgery. All had negative preoperative urine cultures, and prohylactic antibiotics were not used.Postoperative UTI developed in 16 patients (8.3%), i.e. in only 14 of 86 with a positive culture on day 1 after surgery, and in 2 of 107 with a negative culture on day 1. These 16 women received antibiotics; 79 (40.9%) who had transient AB were not treated. There were no cases of upper UTI. Among 31 women discharged with AB, none developed UTI.Although 49.2% of patients in this study had postoperative bacteriuria as measured by midstream culture, only 8.3% of patients actually developed a symptomatic infection requiring treatment. As only a minority (11.3%) of patients with postoperative AB actually developed UTI, it appears that to treat all cases of bacteriuria >100 000 cfu/ml is unnecessary.     

Comparison of 1 and 3 days' transurethral Foley catheterization after vaginal plastic surgery

This prospective study was done to see whether reducing transurethral Foley catheterization from 3 days to 1 would lead to fewer urinary tract infections (UTI) without retention becoming a problem. One hundred and sixty-five women undergoing vaginal plastic repair were randomized to either 1 or 3 days catheterization. Of 82 patients catheterized for 1 day UTI was diagnosed in 12 (14.6%), retention occurred in 18 (22.0%) and 7 (8.5%) required a new catheter. Of 83 patients catheterized for 3 days, the respective figures were 17 (20.5%), 12 (14.5%) and 3 (3.6%). The differences are not statistically significant, therefore catheter time may safely be reduced to 1 day. This may be associated with a reduced infection rate but also somewhat greater rate of retention. If a transurethral catheter is to be used, on balance the two regimens are equivalent.Editorial Comment: From this randomized prospective study it would appear that the time of catheter removal after anterior colporrhaphy with or without other repairs, or a Manchester procedure, is not important as regards the incidence of either infection or retention. No prophylactic antibiotics or cholinergic medications were used. One unanswered question is the degree of retention manifested by these patients. The author defines retention as the need for intermittent catheterization at least once if the patient was distressed or a bladder volume >500 ml was suspected. We are not told what the catheterized volumes were. If the postvoid residual is defined as the inability to void with a truly full bladder during the postoperative period, the term retention is appropriate. However, without a knowledge of the retained volume or the actual bladder capacity it is difficult to interpret the true incidence of retention.