直肠癌根治术后早期拔除留置尿管时间的临床随机对照研究

Randomized Control Study of Extubation Time of Indwelled Urinary Catheter after Rectal Cancer Radical Operation

目的探讨直肠癌根治术后拔除留置尿管后发生急性尿潴留的危险因素及早期拔除留置尿管的适宜时间,为临床早期安全拔管提供依据。方法2007年7—11月在四川大学华西医院选择直肠癌根治术后患者90例随机分为3组,每组30例,分别于术后第2天、第3天及第5天拔除留置尿管。比较拔管后急性尿潴留、泌尿系统感染发生率及下尿路不适症状的情况,同时对拔管后发生急性尿潴留的危险因素进行单因素及Logistic多元回归分析。结果3组患者拔除留置尿管后急性尿潴留发生率比较差异无统计学意义(P>0.05);泌尿系统感染发生率比较差异有统计学意义(P<0.001),术后第2天拔除尿管组泌尿系统感染率低于术后第3天拔除尿管组及术后第5天拔除尿管组;3组患者拔管后下尿路不适症状比较差异有统计学意义(P<0.05),术后第2天拔除尿管组患者不适症状最轻,术后第3天拔除尿管组次之,术后第5天拔除尿管组不适症状较重。将单因素分析中有统计学意义的因素纳入多元回归分析,结果显示只有自主神经保护因素具有统计学意义(P<0.01),部分自主神经保护患者拔管后发生急性尿潴留的危险是完全自主神经保护患者的7.42倍。结论自主神经保护是直肠癌根治手术患者拔除留置尿管后发生急性尿潴留的主要危险因素。与术后第3天及常规第5天拔管相比,直肠癌术后第2天拔除留置尿管可以明显降低患者泌尿系统感染率。对于完全自主神经保护或中高位直肠癌的患者而言,术后第2天为适宜的拔除留置尿管时间。部分自主神经保护或低位直肠癌的患者应适当延长留置尿管时间,以减少拔管后急性尿潴留的发生。

Objective To explore the risk factors of acute urinary retention after the extubation of indwelled urinary catheter after rectal cancer radical operation, so as to provide the basis for clinical early-stage secure extubation. Methods 90 patients hospitalized into our hospital were randomly divided into 3 groups, each with 30. The extubation of the indwelled urinary catheter of the three groups was conducted on the 2nd , 3rd and 5th day after the operation. Then a comparison was made of the three groups＇ incidence rates of acute urinary retention and urinary system infections, and the incidences of urinary passage discomforts, and the single factor and Logistic multi-factor regressive analysis were made of the risk factors of acute urinary retention. Results The difference in the incidence rates of acute urinary retention among the three groups had no statistical significance （P〉0.05）, while that in the incidence rates of urinary system infections did （P〈0.001）, with the incidence rate of the group whose catheters were extubated on the 2nd day lower than those of the other two groups. The urinary passage discomforts of the group whose catheters were extubated on the 2nd day was the slightest, the group on the 3rd day next, and the one on the 5th day the severest. The multi-factor regressive analysis of the significant factors screened by the single factor analysis revealed that only the factor of autonomous nervous protection was statistically significant （P〈0.01）, the risk of urinary retention of patients with partial autonomous nervous protection was 7.42 times of that of patients with whole protection. Conclusion Autonomous nervous protection is the major risk factor of acute urinary retention after the extubation of indwelled urinary catheter after rectal cancer radical operation. Extubation on the 2nd day after the operation can markedly lower the incidence rate of urinary system infections. For patients with whole autonomous nervous protection and those with middle-high-position rectal cancer, the best extubation time should be the 2nd day after the operation; for patients with partial autonomous nervous protection and those with low-position rectal cancer, the catheter should be indwelled longer for minimizing the incidence of acute urinary retention.