Chamberlain D H, Hopkins M P, Roberts J A, McGuire E J, Morley G W, Wang C C
Department of Obstetrics and Gynecology, University of Michigan Medical Center, Ann Arbor 48109-0718.
Gynecol Oncol. 1991 Nov;43(2):98-102. doi: 10.1016/0090-8258(91)90052-7.
Radical hysterectomy has long been a primary mode of therapy for selected gynecologic malignancies. The lower urinary tract is an area associated with complications following this procedure. Lack of satisfactory reflex micturition and urinary retention, diminished bladder sensation, infection, and fistula formation are common adverse sequelae. Prolonged indwelling catheterization is a cornerstone of postoperative management after radical hysterectomy. An alternative regimen consisting of early postoperative catheter removal, with a strict voiding schedule, and intermittent self-catheterization (ISC) for postvoid residuals (PVR) was prospectively investigated. Intermittent self-catheterization was initiated only if the PVR 12 hr after catheter removal was greater than 75 ml. Twenty-six patients who underwent radical hysterectomy were studied. Catheters were removed between the fifth and ninth postoperative day. Eighteen patients (69%) had PVRs less than 75 ml at 12 hr and were successfully managed with a strict voiding schedule only. Eight patients (31%) had 12-hr PVRs greater than 75 ml and were managed with a strict voiding schedule and ISC until the PVR was less than 75 ml for two consecutive voids. These patients were evaluated with fluorourodynamics and none had an abnormal study. Compared to 25 historical control patients, study group median indwelling catheter duration was less (6.0 days compared to 30.0 days) with no increase in postoperative complications. On the basis of these data, early removal of indwelling urinary catheters after radical hysterectomy appears to be an acceptable alternative to long-term catheterization.
根治性子宫切除术长期以来一直是特定妇科恶性肿瘤的主要治疗方式。下尿路是该手术后易出现并发症的部位。缺乏满意的反射性排尿和尿潴留、膀胱感觉减退、感染以及瘘管形成是常见的不良后遗症。长期留置导尿是根治性子宫切除术后管理的基石。前瞻性研究了一种替代方案，即术后早期拔除导尿管，采用严格的排尿计划，并对残余尿量（PVR）进行间歇性自我导尿（ISC）。仅当拔除导尿管12小时后的PVR大于75毫升时才开始间歇性自我导尿。对26例行根治性子宫切除术的患者进行了研究。导尿管在术后第5天至第9天拔除。18例患者（69%）在12小时时PVR小于75毫升，仅通过严格的排尿计划就成功进行了管理。8例患者（31%）12小时的PVR大于75毫升，通过严格的排尿计划和ISC进行管理，直到连续两次排尿的PVR小于75毫升。对这些患者进行了尿动力学评估，结果均正常。与25例历史对照患者相比，研究组的中位导尿管留置时间更短（分别为6.0天和30.0天），且术后并发症没有增加。基于这些数据，根治性子宫切除术后早期拔除留置导尿管似乎是长期导尿的一种可接受的替代方法。
