直肠癌术后尿潴留的预防及处理

PREVENTION AND TREATMENT OF UROSCHESIS AFTER RECTAL CANCER RESECTION

[目的]探讨直肠癌手术后尿潴留形成的原因及处理方法,找出预防及治疗直肠癌手术后尿潴留的措施。[方法]回顾性分析35例直肠癌手术后并发尿潴留患者的临床资料。[结果]Miles手术后尿潴留发生率为26%,直肠前切除及直肠系膜全切除术后尿潴留发生率为9.1%。膀胱移位、盆腔神经损伤及前列腺肥大是引起直肠癌术后排尿困难的主要原因,膀胱静息压降低也是引起直肠癌术后排尿困难的重要因素。术前处理好前列腺肥大问题、避免术中盲目的扩大清扫和极细致的手术操作能够减少术后尿潴留的发生。[结论]直肠系膜全切除术不但能保留肛门、减少直肠癌的复发,也能更好的保全直肠癌手术后的排尿、生殖功能。直肠癌术后尿潴留病人都可以恢复自主排尿功能,处理时要有耐心,等待神经功能的恢复。

[Objective] To discuss the causes of uroschesis after rectal carcinoma resection and to find measures for prevention and treatment. [Methods] The clinical data of 35 cases of uroschesis secondary to rectal carcinoma resection were analyzed retrospectively. [ Results] The uroschesis incidence for Miles surgery was 26%, while for patients who underwent anterior rectum resection and total mesorectal excision, the incidence was 9.1%. The main reasons for dysuria after rectal carcinoma resection were bladder malposition, injury of pelvic nerves and prostatauxe, the decrease of resting pressure of urinary bladder was aslo an important reason. Well preoperative treatment of prostatauxe, avoiding blind expanding intraoperative cleaning and extremely accurate operation could reduce the incidence of urine. [ Conclusions ] Total mesorectal excision （TME） can not only save the anus, reduce the recur of rectal carcinoma, but aslo reserve the postoperative emiction and reproduction functions. All the patients can restore autonomous urination, waiting for the rehabilitatio, of nerves with patience is necessary.