直肠切除术后理想尿引流时间的前瞻性研究

目的:前瞻性地研究直肠切除术后留置尿管1d和5d的尿潴留及尿路感染结果,以探寻术后理想的尿引流时间。方法:126例直肠切除病例,随机分为术后尿引流1d和5d二组,比较二组的结果。结果:1d组64例,5d组62例。1d组尿潴留率25％,5d组为10％(P<0.05);1d组尿路感染率为20％,5d组为42％(p<0.01)。多因素分析表明:1d组低位直肠癌和淋巴结转移是术后急性尿潴留的危险因素(p<0.05)。除外低位直肠癌病例,二组急性尿潴留率无显著差异,但尿路感染率5d组明显高于1d(组(p<0.01)。结论:直肠切除术后尿引流1d适应于多数病人,而低位直肠癌术后需要留置尿管引流5d。

A Randomized Controlled Trial of Optimal Duration of Urinary Drainage after Rectal Resection

Objective: 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 with those for patients undergoing 5 days' catheterization. Results: Patients were randomly assigned to the 1 - day and 5 - days groups(n = 64 and 62,respectively) . Acute urinary retention occurred in 16 patients (25%) in the 1 - day group versus 6(10%) in the 5 - day group (P<0.05) .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<0.01) . Multivatiate analysis revealed the after 1 day of catheterization carcinoma of the low rectum and lymph node metastasis were significant risk factors for acute urinary retention (P< 0.05) .After selection of patients without low rectum carcinoma, the acute urinary retention rate was comparable in both groups, but the urinary tract infection rate was significantly lower in the 1 - day group (p < 0.01) . Conclusions: Our controlled study showed that after rectal resection 1 day of urinary drainage can be recommended for most patients. 5 day drainage should be reserved for patients with low rectal carcinoma.