ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.
ObjectiveTo investigate risk factors of anastomotic fistula after total mesorectum excision (TME) in middle and low rectal cancer. MethodsThe clinical data of 446 patients with middle and low rectal cancer received TME surgery from June 2004 to June 2014 were retrospectively analyzed.Single-factor analysis of risk factors was used by χ2 test,multiple-factor analysis was used by logistic regression analysis. ResultsThere were 36 patients with anastomotic fistula in these 446 patients,which of 22 patients were recovered after conservative treatment,of 14 patients were recovered after colostomy.The results of single-factor analysis showed that the age>60 years,preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,distance from anasto-mosis to anus<5 cm,non-strengthen suture by hand were the risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05).The results of multiple-factor analysis showed that the preoperative hemoglobin<110 g/L,preoperative albumin<35 g/L,accompanied with diabetes mellitus,neoadjuvant chemoradiation,and distance from anastomosis to anus<5 cm were the independent risk factors of anastomotic fistula after TME in the middle and low rectal cancer (P<0.05). ConclusionsRisk of anastomotic fistula after TME in middle and low rectal cancer is higher.Basic complications of patient and local conditions of anastomosis,and intraoperative factors could affect incidence of anastomotic fistula,it should be paid enough attention.In general,most of anastomotic fistula could be cured with conservative treatment,in case of conservative treatment is invalid,colostomy is feasible.