腹腔镜下全直肠系膜切除术后尿管拔除时机和方法探讨

目的:探讨腹腔镜下全直肠系膜切除术后尿管拔除的时机和方法。方法:将102例腹腔镜下全直肠系膜切除术后直肠癌患者随机分为实验组和对照组,每组各51例。实验组术后第4天夹闭尿管,膀胱充盈时拔除尿管,患者自行排尿。对照组术后第4天开始训练膀胱功能,夹闭尿管3~4 h放尿1次,第7~10天患者有尿意感后拔除尿管,患者自行排尿。结果:两组相比较,实验组尿路感染率明显降低,差异具有统计学意义(P=0.014),及早拔除尿管可以减轻下尿路不适症状(P=0.005),而两组患者急性尿潴留需要再次插尿管发生率和住院天数无明显差异(P>0.05)。结论:腹腔镜下全直肠系膜切除术后及早拔除尿管可减轻下尿路不适症状,降低患者尿路感染发生率,拔管前不需要训练膀胱功能,直接拔除尿管,不增加尿潴留和再次插管率。

The study of time and methods of urinary catheter removal after laparo-scopictotal mesorectal excision (TME) for patients with rectal cancer

Objective:To investigate the time and methods of urinary catheter removal after laparoscopic total mesorectal exci-sion (TME) for patients with rectal cancer.Methods:102 patients who underwent laparoscopic TME were randomly divided into inter-vention group(n=51) and control group(n=51).In the experimental group,the urethral catheter was closed at fourth days after the operation,and the urinary catheter was removed when the bladder was filled.In the control group,In the intervention group,the urinary catheter was closed at 4 d after the operation,and the urinary catheter was removed when the bladder was filled.In the control group, bladder function was started 4 d after operation,and the catheter was 3~4 h for 1 times.After 70 to 10 d,the patient had urinary sensa-tion and the catheter was removed.Results:The incidence of urinary tract infection was lower in intervention group than in the control group,the difference was statistically significant (P=0.014).Early removal of urinary catheter could reduce discomfort of lower ure-thra.There was no significant difference in re-catheration rate and hospital stay between the two groups(P>0.05).Conclusions:Lap-aroscopic removal of catheter after total mesorectal excision can reduce symptoms of lower urinary tract,reduce the incidence of urinary tract infection,and do not need to train bladder function before urethral catheter.Direct removal of catheter does not increase urinary re-tention and re intubation rate.