医源性输尿管损伤的早期诊断和治疗

Early diagnosis and management of iatrogenic ureteral injury

目的:分析医源性输尿管损伤的特点,总结医源性输尿管损伤的诊断和治疗经验。方法:回顾性分析1997年1月-2006年2月间收治的58例医源性输尿管损伤患者的致伤原因、治疗时间、方法和效果。结果:58例患者中,妇产科、普通外科手术致伤者分别为52例(90%)和6例(10%)。损伤方式为结扎、缝扎、离断、缺血性坏死,分别为18例、25例、9例和6例。术中发现8例,术后1-3天发现6例,术后4天-1个月内发现29例,术后3个月以上诊治发现15例。损伤后4周内手术者43例,术式包括松解结(缝)扎线9例,输尿管端端吻合17例,输尿管膀胱再植14例,Boari膀胱肌瓣输尿管吻合3例,随访3-24个月,除1例先前有放射治疗史者出现尿外渗外,余42例无肾积水或肾积水减轻;损伤后3个月以上诊治者15例,因严重肾积水行肾切除2例,输尿管膀胱再植8例,Boari膀胱肌瓣输尿管吻合5例,随访示2例出现肾萎缩,余11例肾积水减轻。结论:对医源性输尿管损伤患者,只要无严重感染或放射治疗史,损伤后1个月内早期修复能取得良好治疗效果。

Objective：To analyze the characteristics of iatrogenic ureteral injury and summarize the experiences in diagnosis and treatment of iatrogenic ureteral injury. Methods：From January 1997 to February 2006, the injury causes, the treatment time, the methods of surgical procedures and the results of treatment in 58 patients with iatrogenic ureteral injury were analyzed restropectively. Results：Of 58 cases of iatrogenic urethral injuries, gynecolog- ical and general surgical resulted in ureteral injuries in 52 cases （90%） and 6 cases （10%）. The main injury causes were ligation, suture ligation, complete transection and ischemic necrosis, the number were 18 cases, 25 case, 9 cases and 6 cases respectively. 8 cases were found during operation, 6 cases at 1-3 days after injury, 29 cases at 4 -30 days after injury and 15 cases were diagnosised over 3 months after injury. For 43 patients who were treated in 4 weeks after injury, treatment methods include ureteral suture lysis in 9 cases, end to end ureteral anastomosis in 17 cases, ureteroneocystostomy in 14 cases, Boari flap in 3 cases. Following up 3-24 months, One patient who has radiopraxis history was diagnosised with urinary extravasation. Hydronephrosis were relieved or no hydronephrosis in 42 cases. For 15 cases who were diagnosised over 3 months after injury, treatment methods include nephrectomy in 2 cases, uretoeroneocystosyomy in 8 cases, Boari flap in 5 cases. Renal atrophy existed in 2 cases, hydronephrosis were relieved in 11 cases. Conclusions： For iatrogenic ureteral injury patients, if no serious infection or radiopraxs history, early repair in one month can acheive good therapeutic effects.