中低位直肠癌术后男性患者行膀胱锻炼对膀胱功能恢复影响的前瞻性随机对照研究  

Effect of bladder training on bladder function recovery in the male patients after mid-low rectal cancer surgery:a prospective,open,randomized controlled study

作　　者：谢宇红[1] 王枭杰[1] 陈致奋[1] 池畔[1] 官国先[1] 林惠铭[1] 卢星榕[1] 黄颖[1] 王征琼[1] 王明星[1] 陈洁[1] 李秀英 王敏[1] 郑雪珍 郑细梅 李然[1] 林倩倩 Xie Yuhong;Wang Xiaojie;Chen Zhifen;Chi Pan;Guan Guoxian;Lin Huiming;Lu Xingrong;Huang Ying;Wang Zhengqiong;Wang Mingxing;Chen Jie;Li Xiuying;Wang Min;Zheng Xuezhen;Zheng Ximei;Li Ran;Lin Qianqian(Department of Colorectal Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院结直肠外科,福州350001

出　　处：《中华胃肠外科杂志》2018年第11期1255-1260,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家临床重点专科建设资助项目[卫办医政函(2012)649号];福建省自然科学基金项目(2060203).

摘　　要：目的 探讨中低位直肠癌术后男性患者在拔除尿管前行膀胱功能锻炼的有效性及安全性.方法 研究对象纳入标准为男性患者,经病理确诊为中低位直肠腺癌,肿瘤下缘距离肛缘≤10 cm,且行标准直肠癌根治性手术,包括原发灶所在肠管切除及区域淋巴结清扫;排除标准为既往有前列腺增生病史或前列腺手术史者,术前有排尿困难及尿潴留等膀胱功能障碍者以及行直肠肿瘤局部切除或行扩大切除者.根据以上标准,前瞻性纳入2016年6—12月期间,在福建医科大学附属协和医院结直肠外科就诊的92例患者.根据随机数字表法将纳入患者随机分为膀胱锻炼组(43例)和非膀胱锻炼组(49例).该研究经福建医科大学附属协和医院伦理委员会审批(伦理批件号:2016KY005),并于中国临床试验注册中心(ChiCTR)进行注册(注册号:ChiCTR-IOR-16007995).患者干预的执行、数据的搜集以及分析采用三盲原则,采用信封进行分配隐藏.膀胱锻炼组于术后第1天起常规行膀胱功能锻炼至尿管拔除;非膀胱锻炼组则持续开放导尿管至尿管拔除.导尿管在术后第5天清晨拔除,在患者第1次排尿时记录自主排尿量并检测膀胱残余尿量.在术前及术后,应用国际前列腺症状评分量表(IPSS)对患者的排尿功能进行评价.结果 全组患者年龄为(58.6± 10.9)岁,体质指数为(22.4±2.7) kg/m2,肿瘤下缘距离肛缘距离为(6.5±1.9) cm.两组患者间年龄、体质指数、肿瘤距肛缘距离、术前IPSS评分、术前膀胱残余尿量、新辅助放化疗、预防性回肠造口以及手术方式等基线资料的比较,差异均无统计学意义(均P>0.05).膀胱锻炼组与非膀胱锻炼组初次拔尿管后第2天IPSS评分[(3.6±4.0)分比(3.5±3.4)分,t=0.128,P=0.899]和出院1个月后的IPSS评分[(3.7±2.9)分比(3.0±3.1)分,t=1.113,P=0.269]比较,差异均无统计学意义.两组间术后膀胱残余尿量[中位数44 ml比24 ml,Z=-1.466,P=0.143]和首Objective To investigate the efficacy and safety of the bladder training in male patients before urinary catheter removal after mid-low rectal cancer surgery. Methods This was a prospective, open, randomized controlled study. Inclusion criteria: male patients; pathologically diagnosed as mid-low rectal adenocarcinoma; distance from tumor lower edge to anal margin ≤10 cm;standard radical surgery for rectal cancer, including intestinal resection and regional lymph node dissection. Exclusion criteria: previous history of benign prostatic hyperplasia or history of prostate surgery; bladder dysfunction such as dysuria and urinary retention before surgery; local resection of rectal tumor or extended resection. According to the above criteria, 92 patients who underwent colorectal surgery at the Union Hospital of Fujian Medical University from June to December 2016 were prospectively included. The patients were randomly divided into bladder training group (n=43) and bladder non-training group (n=49) according to the random number table method. The study was approved by the Ethics Committee of the Union Hospital of Fujian Medical University (ethical approval number: 2016KY005) and registered with the China Clinical Trial Registration Center (ChiCTR) (registration No.ChiCTR-IOR-16007995). The implementation of patient′s treatment measures, the data collection and analysis were based on the three-blind principle, using envelopes for distribution concealment. In the bladder training group, bladder training was routinely performed from the first day after operation to catheter removal, and in bladder non-training group the catheter was kept open till its removal. The catheter was removed in the early morning at the 5th day after surgery, and the spontaneous urine output was recorded and the residual urine volume of the bladder was measured after the first urination. The international prostate symptom score (IPSS) was applied to evaluate the patient′s urinary function before and after surgery. Results The age of whole gr

关 键 词：直肠肿瘤 膀胱锻炼 男性 前瞻陆随机对照研究 

分 类 号：R735.37[医药卫生—肿瘤]