摘要
目的 评价总结早期宫颈癌根治性子宫切除术后尿潴留预防护理的最佳证据，为临床护理人员和管理者提供证据支持。方法 根据问题开发工具PIPOST确立早期宫颈癌根治性子宫切除术后尿潴留预防护理的循证问题，系统检索UpToDate临床决策系统、英国国家医疗保健优化研究所（NICE）、苏格兰院际指南网（SIGN）、国际指南协作网（GIN）、加拿大安大略护理学会网站（RNAO）、美国国立癌症综合网络（NCCN）、医脉通、欧洲泌尿外科协会网站（EAU）、国际尿控协会（ICS）、加拿大泌尿外科协会（CUA）、Cochrane Library、OVID-JBI、Pubmed、CNKI、中国万方共15个数据库从建库至2021年6月5日关于早期宫颈癌根治性子宫切除术后尿潴留预防护理的临床决策、循证指南、证据总结、系统评价、专家共识，由2名研究者对文献质量进行评价，并进行证据总结。结果 纳入13篇文献，其中临床决策2篇，循证指南4篇，证据总结4篇，系统评价3篇。从13篇文献中提取最佳证据23条，总结为尿潴留风险评估、手术预防、膀胱引流方式的选择及管理、药物干预、膀胱康复技术、膀胱自我管理六大类。结论 早期宫颈癌根治性子宫切除术后尿潴留预防护理证据支持强，临床医护人员应用证据时需结合临床情境有针对性的应用。
关键词： 早期宫颈癌；根治性子宫切除术；尿潴留；预防；护理；证据总结
Abstract
Objective To evaluate and summarize the best evidence of preventive nursing of urinary retention after radical hysterectomy for early cervical cancer, and provide evidence support for clinical nurses and managers. Methods According to the problem development tool PI POST, the evidence-based problem of prevention and nursing of urinary retention after radical hysterectomy for early cervical cancer was established. The system searches Up To Date clinical decision-making system, British National Health Care Optimization Institute (NICE), Scottish Inter hospital Guidance Network (SIGN), International Guidance Collaboration Network (GIN), Canadian Ontario Nursing Association website (RNAO), American National Cancer Network (NCCN), Medical Pulse, European Urology Association website (EAU), International Urology Association (ICS), Canadian Urology Association (CUA), Cochrane Library, OVID-JBI, Pubmed, CNKI and China Wanfang have 15 databases, from the establishment of the database to June 5, 2021, regarding the clinical decision-making, evidence-based guidance, evidence summary, systematic evaluation and expert consensus on the prevention and care of urinary retention after radical hysterectomy for early cervical cancer. Two researchers evaluated the literature quality and summarized the evidence. Results Thirteen literatures were included, including 2 clinical decisions, 4 evidence-based guidelines, 4 evidence summaries and 3 systematic evaluations. Twenty-three pieces of best evidence were extracted from 13 literatures, which were summarized into six categories: risk assessment of urinary retention, surgical prevention, selection and management of bladder drainage methods, drug intervention, bladder rehabilitation technology and bladder self-management. Conclusion The evidence of prevention and nursing care of urinary retention after radical hysterectomy for early cervical cancer is strong, and the clinical medical staff should apply the evidence in combination with the clinical situation.
Key words： Early cervical cancer; Radical hysterectomy; Urinary retention; Prevention; Nursing; Summary of evidence
参考文献 References
[1] 谢锋,隋龙.子宫颈癌筛查的现状及思考[J].实用妇产科杂志,2020,36(10):721-723.
[2] 宋丹,孔为民.早期宫颈癌患者保留生育功能的研究进展[J].中华临床医师杂志(电子版),2015,9(1):17-20．
[3] Verleye L,Vergote I,Reed N,Ottevanger PB.Quality assurance for radical hysterectomy for cervical cancer: the view of the European Organization for Research and Treatment of Cancer‐Gynecological Cancer Group (EORTC‐GCG). Annals of Oncology 2009,20(10):1631‐8.
[4] Sellers DJ, Chess‐Williams R. Muscarinic agonists and antagonists: effects on the urinary bladder. Handbook of Experimental Pharmacology 2012, (208):375‐400.
[5] Laterza RM, Sievert KD, Ridder D, Vierhout ME, Haab F, Cardozo L, et al. Bladder function after radical hysterectomy for cervical cancer. Neurourology and Urodynamics 2015,34(4):309-15.
[6] 周静.宫颈癌根治术后尿潴留的原因及预防护理进展[J].重庆医学,2012,41(15):1545-1546．
[7] 鲁媛媛,张茹梅,于悦,等.宫颈癌根治术后尿潴留相关因素的分析及防治措施[J].中国生育健康杂志,2017,28(1): 61-63.
[8] Manchana T, Prasartsakulchai C, Santingamkun A. Long‐term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction. International Urogynecology Journal and Pelvic Floor Dysfunction 2010,21(1):95‐101.
[9] Zhou W, Yang X, Dai Y, Wu Q, He G, Yin G. Survey of cervical cancer survivors regarding quality of life and sexual function. Journal of Cancer Research and Therapeutics 2016,12(2):938‐44.
[10] 朱政,胡雁,邢唯杰,等.不同类型循证问题的构成[J].护士进修杂志,2017,32(21):1991-1994.
[11] 胡雁,李晓玲,郝玉芳,等.循证护理学[M].北京:人民卫生出版社,2012:109-110．
[12] Brouwers MC, Kho ME, Browman GP, et al. AGEREEⅡ:Advancing Guideline Development, Reporting and Evaluation in Healthcare[J]. Can Med Assoc J,2010,182(10): E839 -E842.
[13] 熊俊,陈日新.系统评价/Meta分析方法学质量的评价工具AMSTAR[J].中国循证医学杂志,2011,11(9):1084-1089.
[14] The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party.Supporting Document for the Joanna Briggs Institute levels of Evidence and Grades of Recommendation[J].The Joanna Briggs Institute .2014.
[15] Chumnan, Kietpeerakool, Apiwat, et al. Nerve-sparing radical hysterectomy compared to standard radical hysterectomy for women with early stage cervical cancer (stage Ia2 to IIa).[J]. Cochrane Database of Systematic Reviews, 2019.
[16] Blok, B, et al. EAU Guidelines on Neuro-urology. Edn. presented at the EAU Annual Congress Milan Italy 2021. ISBN 978-94-92671-13-4.
[17] Kavanagh A , Baverstock R , Campeau L , et al. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Executive summary[J]. Canadian Urological Association journal = Journal de l'Association des urologues du Canada, 2019, 13(6).
[18] Minooee, Sonia. Post-operative urinary retention(pour):Risk and Prevention. 2021, Cited in: JBI EBP Database at
[19] Minooee, Sonia. Post-Operative Urinary Retention: Assess -ment and Diagnosis. 2021,Cited in:JBI EBP Database at
[20] Aue-Aungkul A , Kietpeerakool C , Galaal K , et al. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer[J]. Cochrane database of systematic reviews (Online), 2017.
[21] Kidd E A , F Stewart, Kassis N C , et al. Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults[J]. Cochrane Database of Systematic Reviews, 2015.
[22] Anthony J Schaeffer.Placement and management of urinary bladder catheters in adults[EB/OL].[2021-3-24].
[23] Glen W Barrisford, Acute urinary retention[EB/OL]. [2020-6-16].
[24] Soumya.Long-Term Catheter :Management and Care .2021, Cited in: JBI EBP Database at Accessed June 19, 2021.
[25] Pamaiahgari, Priyanka.Urinary Catheterization (short-term) : Safe and Effective Use. 2021,Cited in: JBI EBP Database at Accessed June 19, 2021.
[26] G. Bonkat , R. Bartoletti, F. Bruyère et al.EAU Guidelines on Urological Infections. Edn. presented at the EAU Annual Congress Milan Italy 2021.ISBN 978-94-92671-13-4.
[27] 中国康复医学会康复护理专业委员会. 神经源性膀胱护理实践指南(2017年版)[J]. 护理学杂志, 2017, 32(024):1-7.
[28] 王春青,胡雁.JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志,2015,30(11):964-967.
[29] Dicenso A,Bayley L,Haynes RB.Accessing Preappraised Evidence:Fine-tuning the 5S Model into a 6S Model[J].Evid Based Nurs,2009,12(4):99-101.