Benoist S, Panis Y, Denet C, Mauvais F, Mariani P, Valleur P
Department of Surgery, Lariboisière Hospital, Paris, France.
Surgery. 1999 Feb;125(2):135-41.
Voiding dysfunction is frequently observed after rectal resection and justifies urinary drainage. However, there is no agreement about the optimal duration of this postoperative drainage. The aim of this controlled trial was to compare 1 versus 5 days of transurethral catheterization after rectal resection, with special reference to urinary tract infection and bladder retention.
One hundred twenty-six patients undergoing rectal resection were included in a prospective randomized study designed to compare the results for patients undergoing 1 day of transurethral catheterization after rectal resection (1-day group) with those for patients undergoing 5 days' catheterization (5-day group).
Patients were randomly assigned to the 1-day and 5-day groups (n = 64 and 62, respectively). Clinical findings and surgical procedures were comparable in both groups. Acute urinary retention occurred in 16 patients (25%) in the 1-day group versus 6 (10%) in the 5-day group (P < .05). Urinary tract infection was observed in 13 of 64 patients (20%) in the 1-day group versus 26 of 62 (42%) in the 5-day group (P < .01). Multivariate analysis revealed that after 1 day of catheterization carcinoma of the low rectum and lymph node metastasis were significant risk factors for acute urinary retention (P < .05 for both factors). After selection of patients without low rectum carcinoma, the acute urinary retention rate was comparable in both groups (14% in the 1-day group versus 7% in the 5-day group), but the urinary tract infection rate was significantly lower in the 1-day group versus the 5-day group (14% vs 40, P < .01).
Our controlled study showed that after rectal resection 1 day of urinary drainage can be recommended for most patients. Five-day drainage should be reserved for patients with low rectal carcinoma.
直肠切除术后常出现排尿功能障碍，因此需要进行尿液引流。然而，对于术后引流的最佳持续时间尚无定论。本对照试验的目的是比较直肠切除术后经尿道导尿1天与5天的效果，特别关注尿路感染和膀胱潴留情况。
126例接受直肠切除术的患者纳入一项前瞻性随机研究，旨在比较直肠切除术后经尿道导尿1天的患者（1天组）与导尿5天的患者（5天组）的结果。
患者被随机分为1天组和5天组（分别为n = 64和62）。两组的临床发现和手术操作具有可比性。1天组16例患者（25%）发生急性尿潴留，而5天组为6例（10%）（P <.05）。1天组64例患者中有13例（20%）发生尿路感染，5天组62例中有26例（42%）（P <.01）。多因素分析显示，导尿1天后，低位直肠癌和淋巴结转移是急性尿潴留的显著危险因素（两个因素P均<.05）。在选择无低位直肠癌的患者后，两组急性尿潴留率相当（1天组为14%，5天组为7%），但1天组的尿路感染率显著低于5天组（14%对40%，P <.01）。
我们的对照研究表明，直肠切除术后，大多数患者建议进行1天的尿液引流。5天引流应保留给低位直肠癌患者。
