妇科手术输尿管损伤的特点及处理

Characteristics and treatment of ureteral injury in gynecological surgery

目的探讨妇科开腹手术和腹腔镜手术中输尿管损伤的原因、诊断和治疗。方法回顾性分析1464例腹腔镜手术、5410例开腹手术中发生输尿管损伤患者的临床资料,包括损伤部位、类型、诊治情况和预后。结果1464例腹腔镜手术发生输尿管损伤6例(0.41%),5410例开腹手术发生输尿管损伤5例(0.09%),开腹手术输尿管损伤均为恶性肿瘤手术,发生在腹腔镜手术1例为阴式辅助腹腔镜子宫全切,5例为全腹腔镜子宫全切术。术中发现损伤4例,其中2例行膀胱镜下输尿管置管,2例开腹行输尿管吻合加置管。术后发现损伤7例,其中4例行腹腔镜下输尿管置管,3例行开腹膀胱输尿管再植或吻合术。所有患者预后良好。结论输尿管损伤是妇科手术中少见而严重的并发症,多发生于恶性肿瘤的手术和腹腔镜的子宫切除术时,若术中出现腹腔渗液,术后不明原因发热、阴道流液时,应考虑输尿管损伤的可能,应及时明确诊断及早处理。

Objective To investigate ureteral injury in gynecological surgery and discuss its diagnostic treatment and prevention. Methods Data of ureteral injury in 1464 gynecological laparoscopies and 5410 gynecological laparotomies were reviewed retrospectively. The clinical features of the disease uterine size, pelvic adhesion, operative procedures, location, and type of the lesion,time of recognition, and methods of diagnosis,treatment and prognosis injury were analyzed. Results There were 6 ureteral injuries（0.41% ） in 1464 gynecological laparoscopies, and there were 5 ureteral injuries （0. 09% ） in 5410 laparotomies. Four injuries were recognized during operation. The other injureies were found several days later. Six patients received treatment with ureteral catheterization successfully, the others received ureteral repair upon laparotomy（ end to end nastomosis, ureterocystomy）. The outcomes were good in all cases. Conclusion Ureteral injury is an uncommon but severe complication in gynecological operation. Symptoms like unexplained fever, abnormal vaginal discharge postoperation should be paid attention and ureteral injury should he considered. Surgical repair is the primary treatment, hut ureteral catheterization is a good therapy.