经阴道输尿管膀胱移植术治疗妇科阴式手术后医源性输尿管损伤

Vaginal ureteroneocystostomy for iatrogenic ureter injuries after transvaginal surgery

目的探讨医源性下段输尿管离断后经阴道输尿管膀胱移植术的可能性。方法对我院2009年9月及2010年1月2例经阴道广泛子宫切除术后输尿管下段损伤的宫颈癌患者行经阴道输尿管膀胱移植术。结果第1例于手术当中即发现输尿管离断并行手术治疗;第2例术后发现并于32h内行手术治疗。2例手术过程顺利,术中同时行双"J"管置入,术后3个月在膀胱镜下拔除双"J"管,随访无输尿管瘘、输尿管狭窄、肾功能损坏等并发症。结论经阴道手术适用于阴式手术所致输尿管下段离断损伤后修补,相较于开腹或腹腔镜下修补,其创伤小、费用少,所需器械要求低。

Objective To study the possibility of vaginal ureteroneocystostomy for iatrogenic lower ureter injuries after transvaginal surgery.Methods Vaginal ureteroneocystostomy was performed in September 2009 and January 2010,respectively,for two cervical cancer patients with iatrogenic lower ureter injuries after transvaginal surgery.Results Ureter transection was found in 1 patient during operation and in the other patient 32h after operation.The two patients received vaginal ureteroneocystostomy for ureter transaction,during which double-J ureteral stents were inserted and removed at the aid of cystoscope after 3 months.During the follow-up,no severe complications were found such as ureterovaginal stula,obstruction or renal dysfunction.Conclusion Vaginal ureteroneocystostomy can repair the lower ureter transection caused by initial vaginal surgery,with less injuries,lower costs and less instruments than open surgery or laparoscopic surgery.