Kim Hyung Ook, Cho Young Sam, Kim Hungdai, Lee Sung Ryol, Jung Kyung Uk, Chun Ho-Kyung
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29, Saemunan-ro, Jongno-gu, Seoul, 03181, Korea.
Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
World J Surg. 2016 Dec;40(12):3044-3051. doi: 10.1007/s00268-016-3636-5.
Postoperative bladder dysfunction often occurs after rectal cancer surgery, necessitating long-term urinary catheter drainage. The aim of this study was to evaluate the feasibility of early catheter removal and to propose scoring systems that may predict urinary dysfunction after laparoscopic rectal cancer surgery.
A total of 110 patients who underwent elective laparoscopic rectal cancer surgery were included in this prospective observational study. The urinary catheter was removed on the first postoperative day.
The overall incidence of bladder dysfunction was 29.1 % (32/110). The incidence of bladder dysfunction was significantly higher in patients with an age of 65 years or older, male gender, and anastomosis levels from the anal verge of 6 cm or below (P = 0.03, 0.002, and 0.03, respectively). By setting a cut-off of two of the risk factors, this simple scoring system can predict postoperative bladder dysfunction with sensitivity of 96.9 %, specificity of 50.0 %, and accuracy of 63.6 %. A scoring system based on regression coefficients was also conducted according to the following formula: bladder dysfunction predicting score = 18 (1 for male or 0 for female) +0.5 (age, years) -2 (anastomosis level, cm). With this method, a cut-off value of 35+ points predicts postoperative bladder dysfunction with a sensitivity of 81.3 %, specificity of 71.8 %, and accuracy of 74.5 %.
Bladder dysfunction after laparoscopic rectal cancer surgery following early catheter removal occurred in 29.1 % of patients. Two scoring systems using three risk factors (age, male gender, and anastomosis level) may predict postoperative bladder dysfunction.
直肠癌手术后常发生术后膀胱功能障碍，需要长期留置导尿管引流。本研究的目的是评估早期拔除导尿管的可行性，并提出可预测腹腔镜直肠癌手术后膀胱功能障碍的评分系统。
本前瞻性观察性研究纳入了110例行择期腹腔镜直肠癌手术的患者。术后第一天拔除导尿管。
膀胱功能障碍的总体发生率为29.1%（32/110）。年龄65岁及以上、男性以及吻合口距肛缘6 cm及以下的患者膀胱功能障碍发生率显著更高（P分别为0.03、0.002和0.03）。通过设定两个危险因素作为临界值，这个简单的评分系统可以预测术后膀胱功能障碍，敏感性为96.9%，特异性为50.0%，准确性为63.6%。还根据以下公式构建了基于回归系数的评分系统：膀胱功能障碍预测评分=18（男性为1，女性为0）+0.5（年龄，岁）-2（吻合口水平，cm）。采用这种方法，临界值为35分及以上时预测术后膀胱功能障碍的敏感性为81.3%，特异性为71.8%，准确性为74.5%。
早期拔除导尿管后，29.1%的腹腔镜直肠癌手术患者发生膀胱功能障碍。使用三个危险因素（年龄、男性性别和吻合口水平）的两个评分系统可预测术后膀胱功能障碍。
