腹腔镜宫颈癌根治术预置双“J”管的临床价值

Preinstallation of double-J stent in laparoscopic radical hysterectomy

目的探讨术前预置双"J"管在预防和治疗腹腔镜下宫颈癌根治术中及术后输尿管损伤的临床价值。方法回顾性分析解放军总医院2006年1月-2011年1月因宫颈癌行腹腔镜下宫颈癌根治术患者124例,其中16例因评估可能发生输尿管损伤,术前行膀胱镜检查并插入双"J"管,术后3个月拔出。结果在16例预置双"J"管的患者中,1例于术中发现输尿管损伤,未予特殊修补,术后3个月拔出双"J"管,自然修复。108例患者行未置管手术,输尿管损伤6例。其中1例于术中及时发现,立即给予腔镜下修补,置入双"J"管引流;5例损伤由器械热辐射造成,于术后10d左右发现,对其中1例行单纯膀胱镜下置入双"J"管引流;2例行腹腔镜下修补,留置双"J"管引流;2例行肾盂造瘘。结论宫颈癌根治术中预计有输尿管损伤可能者,术前预置双"J"管有助于术中识别输尿管,并可预防和治疗输尿管损伤。

Objective To investigate the clinical significance of preinstallation of double-J stent in prevention and treatment of ureteral injury before and after laparoscopic radical hysterectomy.Methods Data of 124 patients with cervical cancer,who underwent laparoscopic radical hysterectomy in General Hospital of PLA from Jan.2009 to Jan.2011,were retrospectively analyzed.Double-J ureteral catheters were installed using cystoscopy before operation in 16 patients,and the catheters were removed 3 months later.Results Ureteral injury occurred in 1 of 16 patients,the catheter was removed 3 months after operation,and the ureter was then naturally repaired.Ureteral injury occurred in 6 of 108 patients,who underwent laparoscopic surgery without preinstallation of 3 stents.The injury was found during operation in one of the 6 patients,and it was repaired by installation of double-J stent with laparoscopy.The injury was produced by thermal radiation of the instrument in another 5 patients around 10 days after surgery,among them one was repaired by installation of double-J stent with cystoscopy,2 were repaired through laparoscopy,and another 2 were treated with pyelostomy.Conclusion Preinstallation of double-J stent in laparoscopic radical hysterectomy may prevent ureteral injury in patients undergoing the operation.