中心静脉导管膀胱穿刺引流在中低位直肠癌手术中的应用  

Application of Suprapubic Catheterization by Using Central Venous Catheter in Middle and Low Rectal Cancer Surgery

作　　者：蔡圣彬 张宏[1] 丛进春[1] 凌云志[1] 刘鼎盛[1] 崔明明[1] 陈春生[1] 

机构地区：[1]中国医科大学附属盛京医院结直肠肿瘤外科,辽宁沈阳110004

出　　处：《中国普外基础与临床杂志》2015年第12期1471-1476,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：辽宁省自然科学基金资助项目(编号:2013021098)~~

摘　　要：目的探讨应用中心静脉导管(CVC)行耻骨上膀胱穿刺引流(SPC)对围手术期并发症的影响。方法回顾性分析2012年4月至2015年1月期间中国医科大学附属盛京医院收治的141例中低位直肠癌手术患者的临床病例资料,其中应用CVC行SPC 65例(CVC-SPC组),行常规经尿道留置尿管76例(常规TUC组)。分析比较2组患者的菌尿及尿潴留的发生率、再次导尿率、置管时间和导管相关性疼痛的情况。结果 1 CVC-SPC组菌尿发生率明显低于常规TUC组(P=0.002),其中女性(P=0.006)、年龄≥60岁(P=0.001)、低位直肠癌(P=0.003)、行开腹手术(P=0.018)、行Miles术(P=0.016)和行Dixon术(P=0.032)患者的菌尿发生率在CVC-SPC组均明显低于常规TUC组。2 CVC-SPC组和常规TUC组术后尿潴留发生率比较差异无统计学意义(P=0.464)。3 CVC-SPC组再次导尿率明显低于常规TUC组(P=0.001),并且男性(P=0.016)、年龄≥60岁(P=0.008)、低位直肠癌(P=0.019)、行腹腔镜手术(P=0.013)和行Miles术(P=0.037)患者的再次导尿率在CVC-SPC组均明显低于常规TUC组。4 CVC-SPC组疼痛评分明显低于常规TUC组(P=0.001),并且无论男性(P=0.005)还是女性(P=0.01),年龄≥60岁(P=0.023)还是<60岁(P=0.034)、属于中位直肠癌(P=0.017)还是低位直肠癌(P=0.046)、开腹手术(P=0.033)还是腹腔镜手术(P=0.021)、行Dixon术(P=0.019)还是Miles术(P=0.035),CVC-SPC组疼痛评分均明显低于常规TUC组。5 CVC-SPC组和常规TUC组置管时间比较差异无统计学意义(P=0.597)。结论相对于常规经尿道留置尿管,应用CVC行SPC是既安全有效又易被患者所接受的导尿方法。Objective To investigate the effect of suprapubic catheterization （SPC） by using central venous catheter （CVC） on the perioperative complications in middle and low rectal cancer surgery. Methods The clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to lanuary 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization （TUC）. The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results （1） Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria （P=0.002）, espe- cially in female （P=0.006）,≥ 60 years old （P=0.001）, low rectal cancer （P=0.003）, open surgery （P=0.018）, Miles （P=0.016）, and Dixon （P=0.032）. （2） There was no significant difference in the incidence of urinary retention （P=0.464） between the SPC by using CVC and the TUC. （3） Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of recatheterization rate （P=0.001）, especially in the patients with male （P=0.016）, ≥60 years old （P=0.008）, low rectal cancer （P=0.019）, laparoscopic surgery （P=0.013）, and Miles （P=0.037）. （4）Compared with the TUC, the point of catheterrelated pain was significantly lower in the SPC by using CVC （P=0.001）, no matter males （P=0.005） or females （P=0.010）, aged 60 years and older （P=0.023） or younger （P=0.034）, middle rectal cancer （P=0.017） or low rectal cancer （P=0.046）, open surgery （P=0.033） or laparoscopic surgery （P=0.021）, Dixon （P=0.019） or Miles （P=0.035）. （5） The duration of catheterization was similar between the SPC by using CVC and the TUG （P=0.597）. Conclusion SPC by using CVC is a safer, more effective and m

关 键 词：中低位直肠癌 耻骨上膀胱穿刺 中心静脉导管 留置尿管 

分 类 号：R735.37[医药卫生—肿瘤]