常规留置导尿失败后处理急性尿潴留临床方法的对比分析  

Comparative analysis of clinical methods for treating acute urinary retention after failure of routine indwelling catheterization

作　　者：胡海义[1] 李恭会[2] 吴海洋[2] 成晟[2] 陈志强[1] 袁杰[2] 朱世斌[2] HU Haiyi;LI Gonghui;WU Haiyang;CHENG Sheng;CHEN Zhiqiang;YUAN Jie;ZHU Shibin(Department of Urology Surgery,Xiasha Hospital of Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Xiasha Hospital of Hangzhou,Hangzhou310018,China;Department of Urology Surgery,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院下沙院区杭州市下沙医院泌尿外科,浙江杭州310018 [2]浙江大学医学院附属邵逸夫医院泌尿外科,浙江杭州310016

出　　处：《中国现代医生》2020年第10期91-95,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2018KY470)。

摘　　要：目的探讨常规留置导尿失败后处理急性尿潴留留置导尿的不同方法,以期提高患者一次性留置导尿成功率,尽早解除尿路梗阻并减少尿道损伤。方法分析2014年1月~2019年9月我院208例急性尿潴留患者的临床资料,根据治疗方式不同,将患者分为尿道扩张后留置导尿组(尿扩组)和内镜下导丝引导留置组(内镜组),分析两组留置导尿成功率及并发症的差异。结果尿扩组中所有女性患者、无尿道手术史患者及尿道外口狭窄患者经尿道扩张扩后均能成功留置导尿;内镜组中TUR及TURP患者均可成功留置导尿管。TUR及SP患者两组留置尿管成功率无显著性差异(P>0.05)。TURP(P<0.001)及RP(P=0.008)患者内镜组留置尿管成功率均显著高于尿扩组。内镜组留置尿管总成功率明显高于尿扩组(95.7%vs 80.9%,P=0.001);内镜组术中VAS疼痛评分(2.2±0.3 vs 5.7±0.9,P<0.001)及术中明显肉眼血尿发生率(5.4%vs 23.5%,P<0.001)均显著低于尿扩组;术后3个月拔除尿管后,内镜组尿潴留发生率明显低于尿扩组(15.1%vs 28.7%,P=0.02)。结论女性及无尿道手术史的男性患者大多可经尿道扩张后即可成功留置导尿;而对于合并尿道手术史,尤其合并前列腺手术史的男性患者,内镜下留置导尿管优于单纯尿道扩张。Objective To investigate different methods for treating indwelling catheterization for acute urinary retention after failure of routine indwelling catheterization,so as to improve the success rate of one-time indwelling catheterization for patients,relieve urinary obstruction as soon as possible,and reduce urethral injury.Methods The clinical data of 208 patients with acute urinary retention in our hospital from January 2014 to September 2019 were analyzed.According to different therapeutic regimens,patients were divided into the group performed with indwelling catheterization after urethral dilatation(urethral dilatation group)and the endoscopic guidewire-guided indwelling group(endoscopic group).The differences in success rate and complications of indwelling catheterization between the two groups were analyzed.Results All the female patients,the patients without history of urethra operation and the patients with stricture of external orifice in the group of urinary dilatation were able to indwelling catheterization successfully.In the endoscopic group,TUR and TURP patients could be placed catheter successfully.There was no significant difference in the success rate of indwelling catheter in TUR and SP patients between the two groups(P>0.05).The success rate of indwelling catheter in TURP(P<0.001)and RP(P=0.008)patients in the endoscopic group was significantly higher than that in urethral dilatation group.The overall success rate of indwelling catheterization in the endoscopic group was significantly higher than that in the urethral dilatation group(95.7%vs 80.9%,P=0.001).The intraoperative VAS pain score(2.2±0.3 vs 5.7±0.9,P<0.001)and the intraoperative incidence of obvious macroscopic hematuria(5.4%vs 23.5%,P<0.001)in the endoscopic group were significantly lower than those in the urethral dilatation group.After catheter removal 3 months after surgery,the incidence of urinary retention in the endoscopic group was significantly lower than that in the urethral dilatation group(15.1%vs 28.7%,P=0.02).Conclusion

关 键 词：急性尿潴留 常规留置导尿 困难性留置导尿 尿道扩张 膀胱造瘘术 

分 类 号：R472[医药卫生—护理学]