Buller R E, Tamir I L, DiSaia P J, Berman M L
Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, Orange.
Obstet Gynecol. 1991 Nov;78(5 Pt 1):840-4.
One hundred ten consecutive patients with invasive gynecologic cancers, treated by radical hysterectomy at The University of California, Irvine Medical Center, underwent early postoperative intravenous pyelogram (IVP). An abnormal early postoperative IVP did not predict subsequent urinary tract dysfunction (anatomical defect or disrupted voiding pattern) at 3 months, which occurred in 29% of the patients, nor did it detect any unsuspected fistulas or ureteral obstruction that persisted beyond the 3-month follow-up. Urinary tract dysfunction was not significantly associated with tumor volume, operative blood loss, or the type of radical hysterectomy performed. However, the inability to remove a suprapubic catheter before the 21st postoperative day was associated with a significant increase in urinary tract dysfunction at 3 months (P less than .03). We conclude that, in the absence of intraoperative urinary tract injury or clinical symptoms suggesting fistula or ureteral obstruction, the routine use of postoperative IVP should be abandoned.
110例在加利福尼亚大学欧文医学中心接受根治性子宫切除术治疗的连续性浸润性妇科癌症患者接受了术后早期静脉肾盂造影（IVP）。术后早期IVP异常并不能预测3个月时随后发生的尿路功能障碍（解剖缺陷或排尿模式紊乱），29%的患者出现了这种情况，它也未检测到任何持续超过3个月随访期的未被怀疑的瘘管或输尿管梗阻。尿路功能障碍与肿瘤体积、手术失血量或所施行的根治性子宫切除术类型无显著相关性。然而，术后第21天前无法拔除耻骨上导尿管与3个月时尿路功能障碍的显著增加相关（P小于0.03）。我们得出结论，在没有术中尿路损伤或提示瘘管或输尿管梗阻的临床症状的情况下，应放弃术后IVP的常规使用。
