膀胱灌注治疗宫颈癌根治术后尿潴留疗效观察

膀胱灌注治疗宫颈癌根治术后尿潴留疗效观

察

作者：黄宝珠阮国锋廖秀芳

【摘要】目的了解膀胱灌注治疗宫颈癌术后尿潴留的效果。方法 60例首次行广泛性全子宫切除术+盆腔淋巴结清扫术的宫颈癌患者随机分为观察组（n=30）和对照组（n=30），两组均采取综合治疗护理措施，对照组采用传统的方法拔除尿管后测残余尿量，若残余尿量＞100ml予重新留置尿管3d。观察组在综合治疗护理措施的基础上加用膀胱灌注保留膀胱灌洗液，拔除尿管后不再留置导尿管。结果观察组有3例发生尿潴留，对照组有10例发生尿潴留，两组差异有统计学意义（P < 0.05）。结论综合护理配合膀胱灌注保留膀胱灌洗液对治疗宫颈癌术后尿潴留有效。

【关键词】膀胱灌注；保留膀胱灌洗液；宫颈癌根治术；尿潴留；术后并发症

【Abstract】Objective To evaluate the effect of treating uroschesis after operation for Invasive Cervical Cancer by perfusion through bladder，Methods60 patients of Invasive Cervical Cancer who have had radical hysterectomy and pelvic lymphadenectomy are diveded in two groups randomly. One group is Observation Group （n=30）and the other one is control group （n=30）. In both two groups, the patients get a systematic nursing and treatment. In the control group we use the trational

mathod which is measuring the residual urine of patients after pulling out the catheter, if the residual urine is more than 100ml, the catheter would be left for another 3days. In the observation group, perfusion through bladder is used on systematic nursing and treatment basis, so the irrigating solution is retained in the bladder. And no more catheter is left after pulling out.ResultsIn the obeservation group 3 patients get a uroschesis and 10 in the control group. There is a remarkable difference between the two groups(p<

0.05).Conclusionperfusion through bladder and retaining the irrigating solution on systematic nursing basis is effctive for uroschesis after operation for Invasive Cervical Cancer.

【Key words】Perfusion through bladder; Retaining the irrigating solution; Operation for Invasive Cervical Cancer ;Uroschesis; Complication after operation

子宫颈癌是女性生殖道最常见的恶性肿瘤，包括子宫颈鳞癌和腺癌，目前认为早期子宫颈癌如Ⅰ期及Ⅱ a 多采取手术治疗，手术方式为广泛全子宫切除术+盆腔淋巴结清扫术，由于手术范围广泛，必须游离输尿管，分离膀胱及直肠窝，常容易损伤支配膀胱神经，同时术后膀胱逼尿肌功能减弱，影响膀胱功能而致排尿困难，尿潴留[ 1 ]。尿潴留是指术后14d以上仍不能自行排尿或虽能自行排尿但残余尿量>100ml。本文是观察综合护理配合膀胱灌注保留灌洗液

的方法治疗宫颈癌术后尿潴留的疗效，现将结果报告如下。

1 资料与方法

1 . 1观察对象 2006年12月至2007年12月在我院全麻下行广泛全子宫切除术+盆腔淋巴结清扫术的宫颈癌患者60名，术前排除泌尿系疾患。随机分为观察组和对照组两组，观察组30例，年龄24～66岁，平均45岁；按国际妇产科联盟FIGO1995年修订的分期标准，宫颈癌Ⅰa期17例，Ⅰb期8例，Ⅱa期4例，Ⅱb期1例。对照组30例，年龄31～71岁，平均46.7岁。宫颈癌Ⅰa期15例，Ⅰb期7例，Ⅱa期6例，Ⅱb期2例，两组患者在年龄、临床分期方面具可比性。

1 . 2方法 40例均于术前30 min留置14号 Foley氏双腔气囊导尿管。对照组术后7d开始锻炼膀胱，白天夹尿管，每2h开放一次或感觉到尿急是开放尿管，夜间持续引流，连续3d后予拔除尿管，让患者自行排尿2～3次后测残余尿量，若残余尿量多于100ml，重新留置导尿管配合针灸、理疗锻炼恢复膀胱功能。3d后拔除尿管后再测残余尿量，若>100ml，予留置尿管3d。观察组术后7d开始锻炼膀胱及膀胱灌注，于呋喃西林400～500ml加入利多卡因0.1g用灌肠袋接导尿管快速灌入膀胱，30min内滴完，将灌洗液留在膀胱内半小时后开放尿管，将膀胱内的液体引流出来，然后再夹闭导尿管，每天一次灌洗一次，然后每2h开放一次或感觉到尿急时开放尿管，夜间持续引流，连续3天后在患者有尿意时予拔除尿管，让患者自行排尿，排尿过程双手掌放在膀胱底，向下轻轻推移按压，尽量将残余尿液引出，