膀胱造瘘带管法在广泛全子宫切除术后的应用

The value of using bladder colostomy tube after extensive whole hysterectomy

目的 探讨膀胱造瘘带管法在广泛全子宫切除术后的应用价值.方法 将60例广泛全子宫切除术患者据术后膀胱功能恢复期导尿方法的不同分为2组,研究组24例行耻骨联合上穿刺膀胱造瘘带管术,对照组36例行常规经尿道留置尿管法.比较2组患者术后由于排尿困难重插尿管率、患者的接受程度及术后尿路感染的发生率.结果 研究组重插尿管率为8.0%（2/24）、患者抗拒率为8.0%（2/24）;对照组重插尿管率为67%（22/36）,患者抗拒率为64.0%（23/36）.研究组重插尿管率和患者抗拒率均明显低于对照组,差异有统计学意义（均P＜0.05）.2组拔管后尿常规均正常,未发生泌尿系感染.研究组患者拔除膀胱造瘘管后均未发生尿液外渗及伤口愈合不良等远近期并发症.结论 膀胱造瘘带管法避免了反复尿道插管,并且不增加术后的尿路感染率,值得在广泛全子宫切除术后推广应用.

Objective To observe the value of using bladder colostomy tube method after extensive whole hysterectomy. Methods Sixty patients were divided into two groups according to catheterization methods in postoperative bladder function recovery. Twenty-two patients who underwent the operation of bladder biopsy colostomy tube insertion method on pubic symphysis were enrolled as research team;36 patients who underwent the operation of conventional transurethral indwelling urinary tube method were control group. The rate of second plug urinary canal proportion due to voiding difficulties,patients acceptance and the incidence of postoperative urinary infection were compared. Results In the research team,the rate of second plug urinary canal proportion was 8.0% （2/24） and the rate of patients＇ resistance is 8.0% （2/24）. In the contrast team,the rate of second plug urinary canal propertion was 67% （22/36） and the rate of patient＇ resistance was 64% （23/36）. The rate of second plug urinary canal proportion and the rate of patient＇ resistance in the research team were both lower than those in the contrast team.Routine urines of both teams after decannulation were normal and no recurrent urinary tract infections happened.Complications such as urine leakage and wound healing adverse were not observed in the research team neither.Conclusions The bladder colostomy tube method avoids the urethra intubation of patients,but the incidence of postoperative urinary infection. is not improved.