经阴道根治性子宫切除术中泌尿系统损伤的防治

Prevention and treament of urinary system injury in vaginal radical hysterectomy

目的研究经阴道根治性子宫切除术(VRH)术中泌尿系统损伤的原因,探讨预防泌尿系统损伤的方法。方法对2具女性尸体解剖结果及2006年9月至2008年1月在南方医科大学南方医院等4家医院就诊的43例因子宫恶性肿瘤行VRH的患者的手术情况进行分析。结果(1)VRH术中损伤膀胱的常见步骤为:①分离膀胱阴道间隙。②打开阴道上中隔。③分离膀胱侧间隙。④切断膀胱宫颈阴道韧带(VCVL)浅层膝下部寻找输尿管膝部时。(2)VRH术中损伤输尿管的常见步骤为:①解剖VCVL浅层膝下部寻找输尿管膝部时。②切除子宫主韧带(CL)。③切除宫骶韧带(USL)。(3)43例患者均成功实施VRH,其中损伤膀胱1例,损伤右侧输尿管1例,泌尿系损伤率为4.65%(2/43)。结论根据VRH术中可能损伤泌尿系统的常见原因和步骤,制定相应的手术方法和步骤,可以降低甚至避免泌尿系统的损伤。

Objective To explore causes and prevention methods of urinary system injury in the vaginal radical hysterectomy （VRH）. Methods We analyzed the intraoperative situations of VRH in 43 patients with malignant tumor of uterus based on studying on two female cadavers. Results To protect bladder , we should be more careful when we do these following steps ： separation of the space between bladder and vagina , opening the vaginal kaminaka diaphragm , separation of paravesical space and cutting off the superficial layer of vesico-cervical-vaginal ligament（VCVL）. To protect the ureter, we should pay more attention to the anatomy of the superficial layer of VCVL when finding the knee of the ureter,the resection of cardinal ligament （CL） and the resection of uterosacral ligament （USL）. When doing VRH, one patient got bladder injury and another one had her right ureter injured among the 43 patients. The rate of the urinary system injury is 4.65%. Conclusion According to the causes, surgeon can take corresponding measures to avoid urinary system injury.