耻骨上与经尿道导尿术在男性直肠癌手术中膀胱引流的对比（GRECCAR10），一项随机临床试验。
Suprapubic versus transurethral catheterization for bladder drainage in male rectal cancer surgery (GRECCAR10), a randomized clinical trial.
发表日期：2024 Jul 02
作者：
B Trilling, F Tidadini, Z Lakkis, M Jafari, A Germain, E Rullier, J Lefevre, J J Tuech, A Kartheuser, D Leonard, M Prudhomme, G Piessen, J M Regimbeau, E Cotte, D Duprez, B Badic, Y Panis, M Rivoire, B Meunier, G Portier, J L Bosson, A Vilotitch, A Foote, Y Caspar, P Rouanet, J L Faucheron,
来源：
Techniques in Coloproctology
摘要：
膀胱引流系统地应用于直肠癌手术；然而，最佳的引流类型，经尿道导尿术（TUC）或耻骨上导尿术（SPC），仍然存在争议。目的是比较直肠癌手术后，无论何时拔除尿路引流管，TUC 和 SPC 术后第四天 (POD4) 的尿路感染率。这项随机临床试验在 19 个专家结直肠手术中心进行法国和比利时的研究于 2016 年 10 月至 2019 年 10 月期间进行，纳入了 240 名男性（排尿功能正常或低于正常），接受直肠癌低位吻合术的直肠系膜切除术。在术后第 4 天、第 30 天和第 180 天对患者进行随访。在 208 名患者（中位年龄 66 岁 [IQR 58-71]）中，随机接受 TUC (n = 99) 或 SPC (n = 109) 组，尿路感染发生率无论引流类型如何，POD4 均无显着差异（11/99 (11.1%) 与 8/109 (7.3%)，95% CI，- 4.2% 至 11.7%；p = 0.35）。 TUC 组的脓尿明显增多（79/99 (79.0%) 与 (60/109 (60.9%)，95% CI，5.7-30.0%；p = 0.004）。未观察到菌尿差异TUC 组患者的导管插入时间较短（中位 4 [2-5] 天 vs. 4 [3-5] 天；p = 0.002）。对于接受中段和/或下段直肠癌手术的男性患者，TUC 应优先于 SPC，因为其并发症发生率较低且导管插入时间较短。ClinicalTrials.gov 标识符 NCT02922647.© 2024。Springer Nature Switzerland AG。
Bladder drainage is systematically used in rectal cancer surgery; however, the optimal type of drainage, transurethral catheterization (TUC) or suprapubic catheterization (SPC), is still controversial. The aim was to compare the rates of urinary tract infection on the fourth postoperative day (POD4) between TUC and SPC, after rectal cancer surgery regardless of the day of removal of the urinary drain.This randomized clinical trial in 19 expert colorectal surgery centers in France and Belgium was performed between October 2016 and October 2019 and included 240 men (with normal or subnormal voiding function) undergoing mesorectal excision with low anastomosis for rectal cancer. Patients were followed at postoperative days 4, 30, and 180.In 208 patients (median age 66 years [IQR 58-71]) randomized to TUC (n = 99) or SPC (n = 109), the rate of urinary infection at POD4 was not significantly different whatever the type of drainage (11/99 (11.1%) vs. 8/109 (7.3%), 95% CI, - 4.2% to 11.7%; p = 0.35). There was significantly more pyuria in the TUC group (79/99 (79.0%) vs. (60/109 (60.9%), 95% CI, 5.7-30.0%; p = 0.004). No difference in bacteriuria was observed between the groups. Patients in the TUC group had a shorter duration of catheterization (median 4 [2-5] vs. 4 [3-5] days; p = 0.002). Drainage complications were more frequent in the SPC group at all followup visits.TUC should be preferred over SPC in male patients undergoing surgery for mid and/or lower rectal cancers, owing to the lower rate of complications and shorter duration of catheterization.ClinicalTrials.gov identifier NCT02922647.© 2024. Springer Nature Switzerland AG.