妇科手术泌尿系损伤的诊断与防治

The diagnosis and management of urinary tract injury in gynecologic surgery

目的泌尿系损伤是妇科手术最常见的并发症之一。本研究探讨妇科手术中泌尿系损伤的诊断与治疗,以便及早诊断,及早治疗,避免肾功能受损。方法对北京大学人民医院2000年1月至2008年7月间妇科手术进行回顾性分析。结果妇科手术共13380例,共发生泌尿系损伤13例(0.09%)。13例中开腹手术9例/8072例,发生率为0.1%,其中恶性肿瘤6例均为输尿管损伤,良性疾病3例均为膀胱后壁损伤;腹腔镜手术4例/4684例,发生率为0.08%,均为妇科良性疾病,其中输尿管损伤1例,膀胱后壁3例。损伤部位包括输尿管骨盆入口处3例,下段5例,入膀胱壁内段1例。膀胱损伤4例,均位于膀胱后壁。2例术中发现,11例术后经测定引流液肌酐水平及影像学检查确诊,12例均经再次手术修补成功,1例放置输尿管支架3个月保守治疗成功。结论妇科手术泌尿系损伤中最常见的是恶性肿瘤手术,其次是腹腔镜手术,大多数患者经及早诊断、及时处理后,预后较好。

Objective Urinary tract injury is the most common complication in gynecologic surgery. To study the reason, diagnosis and management of urinary tract injury in gynecologic surgery in order to avoiding injury of kidney function. Methods During the study period from Jan 1, 2000 to July 31, 2008, thirteen patients with u- rinary tract injury in gynecologic surgery were analyzed retrospectively focusing on type and time of injury, diagnostic methods and management of urinary fistula. Results There were 13 380 gynecologic surgeries. The rate of urinary tract injury was9/8 072 （0.10%） in laparotomic surgery. Six of malignant tumors were all ureter injury, three benign disease were injured at hack of the bladder. The rate of urinary tract injury was 4/4 684 （0.08%） in laparoscopic surgery. All of these were benign disease in gynecology, including 1 ureteral injury and 3 injuries at back of bladder. In this group, Of the 9 ureteral injuries 5 occurred in the lower ureter, 1 occurred at the level of vecical entrance and 3 were in the region of the infundibulopelvic ligaments. Of the bladder injuries, all of 4 occurred at back of bladder. Two of these were diagnosed during operation. The others were diagnosed by image examination and comparing the concentration of urea creatine in drainage fluid with those in urine and blood. 12 restoring surgeries were successful by operation. One injury ureter was placed trestle and was removed after three months. Conclusions Most of urinary tract injuries in gynecologic surgery were malignant tumor, the second were in laparoscopic surgery. Most had optimal results when they were diagnosed early and treated correctly.