目的:急性尿潴留(AUR)是结直肠手术中常见的术后并发症。在盆腔结直肠手术中,术后导尿管使用的最佳持续时间存在争议.这项系统评价和荟萃分析旨在比较早期(POD1),中间(POD3),和晚期(POD5)拔除导尿管。
方法:Medline,EMBASE,中部,并搜索了PubMed数据库。如果将POD1或更早拔除导尿管的患者与POD2或更晚在盆腔结直肠大手术中拔除导尿管的患者进行比较,则文章有资格纳入。主要结果是术后AUR的发生率。次要结果是术后尿路感染(UTI)的发生率。
结果:从691篇相关引文中,纳入了5项928例患者的研究.POD1与POD3的导尿管拔除比较显示尿潴留率无显著差异(RR1.36,95CI0.83-2.21,P=0.22);与POD5相比,AUR的发生率明显更高(RR2.58,95CI1.51-4.40,P=0.0005)。UTI的发生率在POD1和POD3之间没有显着差异(RR0.40,95CI0.05-3.71,P=0.45),但与POD1相比,POD5的去除显着增加了UTI的风险(RR0.50,95CI0.31-0.81,P=0.005)。
结论:与早期拔除相比,术后晚期拔除导尿管可将AUR的风险降至最低。但以增加UTI风险为代价。在决定术后导尿的最佳持续时间时,应考虑患者的特定因素。
OBJECTIVE: Acute urinary retention (AUR) is a common postoperative complication in colorectal surgery. In pelvic colorectal operations, the optimal duration for postoperative urinary catheter use is controversial. This systematic
review and meta-analysis aims to compare early (POD 1), intermediate (POD 3), and late (POD 5) urinary catheter removal.
METHODS: Medline, EMBASE, CENTRAL, and PubMed databases were searched. Articles were eligible for inclusion if they compared patients with urinary catheter removal on POD 1 or earlier to patients with urinary catheter removal on POD 2 or later in major pelvic colorectal surgeries. The primary outcome was rate of postoperative AUR. The secondary outcome was rates of postoperative urinary tract infection (UTI).
RESULTS: From 691 relevant citations, five studies with 928 patients were included. Comparison of urinary catheter removal on POD 1 versus POD 3 demonstrated no significant difference in rate of urinary retention (RR 1.36, 95%CI 0.83-2.21, P = 0.22); however, compared to POD 5, rates of AUR were significantly higher (RR 2.58, 95%CI 1.51-4.40, P = 0.0005). Rates of UTI were not significantly different between POD 1 and POD 3 urinary catheter removal (RR 0.40, 95%CI 0.05-3.71, P = 0.45), but removal on POD 5 significantly increased risk of UTI compared to POD 1 (RR 0.50, 95%CI 0.31-0.81, P = 0.005).
CONCLUSIONS: Risk of AUR can be minimized with late postoperative urinary catheter removal compared to early removal, but at the cost of increased risk of UTI. Patient-specific factors should be taken into consideration when deciding upon optimal duration of postoperative urinary catheterization.