不常规留置尿管在肺癌微创手术加速康复外科中的应用

Application of Non-conventional Indwelling Catheter in Enhanced Recovery after Surgery of Minimally Invasive Surgery for Lung Cancer

目的探讨经电视胸腔镜(VATS)行肺癌手术患者不常规留置导尿管促进快速康复的临床效果。方法85例VATS下行肺癌根治术患者经术前评估,17例术中放置尿管术后麻醉清醒前拔除尿管(处置组),其余68例随机分为非留置尿管组(术中不留置尿管)及留置尿管组(术中常规留置尿管)各34例。观察患者手术时间、术中出血量等情况及尿潴留、尿路感染、排尿不适等不良反应发生情况。结果非留置尿管组无尿潴留等不良反应。处置组术后出现排尿困难引起尿潴留2例,尿路感染2例,尿道或排尿不适3例。留置尿管组术后出现尿潴留6例,尿路感染8例,尿道或排尿不适4例。组间比较差异有统计学意义(P<0.05)。结论腔镜肺癌手术不常规留置尿管不增加手术时间、术中出血量等,可以明显减轻患者痛苦,提高术后舒适度,减少并发症等,更符合加速康复外科理念。

Objective To investigate the clinical effect of non-conventional indwelling catheter in patients undergoing lung cancer surgery by video-assisted thoracoscopic surgery(VATS)to promote rapid recovery.Methods A total of 85 patients undergoing radical resection of lung cancer under VATS were evaluated before operation.17 patients were placed with urinary catheter during operation and the urinary catheter was removed before anesthesia(treatment group).The remaining 68 patients were randomized into non-indwelling urinary catheter group(no indwelling urinary catheter during operation)and indwelling urinary catheter group(routine indwelling urinary catheter during operation),with 34 cases in each group.The operation time,intraoperative blood loss,urinary retention,urinary tract infection,urination discomfort and other adverse reactions were observed.Results There were no adverse reactions such as urinary retention in the non-indwelling catheter group.In the treatment group,there were 2 cases of urinary retention caused by dysuria,2 cases of urinary tract infection,and 3 cases of urethral or urination discomfort.There were 6 cases of urinary retention,8 cases of urinary tract infection and 4 cases of urethral or urination discomfort in the indwelling catheter group.The difference between groups was statistically significant(P<0.05).Conclusion Laparoscopic lung cancer surgery without routine indwelling catheter does not increase the operation time,intraoperative blood loss,etc.It can significantly reduce the pain of patients,improve postoperative comfort,reduce complications.So it is more in line with the concept of enhanced recovery after surgery.