Duration of indwelling urethra catheter after laparoscopic ureteral reconstruction surgery: a retrospective study of 100 cases in a single center
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摘要: 目的 探讨腹腔镜输尿管修复术后留置导尿管的合理时间。方法 回顾性分析2019年1月—2021年12月收治的100例输尿管狭窄患者的病例资料。其中男59例，女41例；年龄8~69岁，平均36.7岁。输尿管狭窄段长度均≤2 cm；中上段采用肾盂成形术或输尿管端端吻合术，下段行输尿管膀胱再植术，术后留置输尿管支架管、导尿管、术区引流管引流。根据导尿管留置时间将患者分为A组(>3 d，58例)和B组(3 d，42例)，比较两组导尿管相关并发症、拔管后并发症发生情况及手术成功率。结果 留置导尿管期间，A、B组膀胱刺激征分别为43例(74.1%)和16例(38.1%)，尿路感染分别为27例(46.6%)和7例(16.7%)，导尿管拔出时间分别为(5.6±2.1) d和(3.0±0.0) d，两组间比较均差异有统计学意义(均P < 0.05)。A组和B组术后4 d术区总引流量分别为(424.3±243.2) mL和(382.9±72.5) mL，术后发热分别为9例(15.5%)和6例(14.3%)，吻合口漏尿分别为3例(5.2%)和2例(4.8%)，拔管前复查CT发现吻合口周围包裹性积液形成各1例(2.4%)，手术成功率分别为96.6%(56/58)和95.2%(40/42)，两组间比较均差异无统计学意义。结论 腹腔镜输尿管修复术治疗输尿管狭窄(狭窄长度≤2 cm)后，导尿管留置3 d安全有效，并未增加输尿管吻合口漏尿发生率，且可减少导尿管相关并发症发生。Abstract: Objective To explore the reasonable indwelling time of catheter after laparoscopic ureteral reconstruction surgery.Methods We retrospectively reviewed 100 patients who suffered from the ureteral stricture from January 2019 to December 2021, including 59 male cases and 41 female cases. The mean age of enrolled patients was 36.7 years old (range 8-69 years old). All ureteral stricture length was less than 2 cm. Pyeloplasty or end-to-end ureterostomy was performed for upper or middle ureteral strictures while the ureteral reimplantation was performed for lower ureteral strictures. Ureteral stents, catheters and drainage tubes were indwelt postoperatively. The patients were divided into two groups according to different indwelling time of catheter(group A>3 days and group B 3 days). There were 58 cases in group A and 42 cases in group B. The catheter associated complications, post-extubation complications and surgical success rate were compared.Results During indwelling catheter, in group A and B, the bladder irritative symptoms occurred in 43 cases (74.1%) and 16 cases (38.1%), the urinary tract infection occurred in 27 cases (46.6%) and 7 cases (16.7%), the time of the catheter being pulled out were (5.6±2.1) d and (3.0±0.0) d, respectively. All differences were statistically significant(P < 0.05). In group A and B, the total volume of 4-day drainage were (424.3±243.2) mL and (382.9±72.5) mL, the postoperative fever occurred in 9 cases (15.5%) and 6 cases (14.3%), the anastomotic leakage occurred in 3 cases (5.2%) and 2 cases (4.8%), the peri-anastomotic fluid collection occurred in 1 case (2.4%) and 1 case (2.4%), the surgical success rate were 96.6% (56/58) and 95.2% (40/42), respectively. However, these differences were not statistically significant.Conclusion The 3-day indwelling time of catheter after surgery is safe and effective for laparoscopic ureteral reconstruction on repair of ureteral stricture(ureteral stricture length ≤ 2 cm), since it may not increase the incidence of ureteral anastomotic leakage and reduce the occurrence of catheter associated complication.
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Key words:
- ureteral stricture /
- ureteral reconstruction /
- laparoscopic /
- catheter
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表 1 A组与B组患者一般资料比较
X±S 项目 A组(58例) B组(42例) χ2值 P值 年龄/岁 45.7±14.5 43.1±14.1 -0.904 0.368 BMI/(kg·m-2) 25.0±2.9 24.5±3.2 -0.765 0.446 男/女/例 32/26 24/18 0.038 0.845 狭窄长度/cm 1.3±0.4 1.3±0.4 -1.125 0.263 狭窄部位/例(%) 3.503 0.173 上段 26(44.8) 14(33.3) 中段 15(25.9) 8(19.0) 下段 17(29.3) 20(47.6) 狭窄病因/例(%) 0.225 0.973 输尿管结石术后 26(44.8) 17(40.5) 妇科手术术后 10(17.2) 8(19.0) 先天性狭窄 11(19.0) 9(21.4) 其他 11(19.0) 8(19.0) 
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表 2 A组与B组患者术中及术后资料比较
例(%)，X±S 项目 A组(58例) B组(42例) χ2值 P值 手术时间/min 146.4±33.5 150.2±34.6 0.556 0.580 导尿管拔除时间/d 5.6±2.1 3.0±0.0 -9.653 < 0.001 4 d术区总引流量/mL 424.3±243.2 382.9±72.5 1.225 0.225 引流管拔除时间/d 6.8±2.2 4.6±1.4 5.912 < 0.001 术后住院时间/d 7.5±2.5 5.7±1.6 -4.505 < 0.001 术后并发症 发热 9(15.5) 6(14.3) 0.029 0.865 吻合口漏尿 3(5.2) 2(4.8) 0.009 1.000a) 泌尿道感染 27(46.6) 7(16.7) 9.695 0.002 膀胱刺激征 43(74.1) 16(38.1) 13.082 < 0.001 吻合口周围积液形成 1(1.7) 1(2.4) 0.054 1.000a) 手术成功率/% 96.6 95.2 0.109 1.000a) a)Fisher检验。
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