妇科腹腔镜手术中输尿管损伤的临床特点和处理

URETERAL INJURY IN GYNECOLOGICAL LAPAROSCOPY

目的:探讨妇科腹腔镜手术中输尿管损伤的部位、主要原因及诊断、治疗和预防的方法。方法:回顾性分析我院8年间妇科腹腔镜手术中发生输尿管损伤患者的临床资料、损伤的部位、损伤原因、诊断、治疗及预后。结果:3654例妇科腹腔镜手术中,共发生输尿管损伤8例,发生率为0.22%,8例患者均行腹腔镜辅助式子宫切除术(LAVH),腹腔镜手术输尿管损伤的部位均位于子宫动脉、子宫骶棘韧带、膀胱入口附近,输尿管损伤症状包括:引流量增多、腹痛或腹胀、腰疼、恶心呕吐、发热、尿量减少、阴道流水、腹部皮下水肿、腹膜炎等。确诊方法主要为B超、膀胱镜检查、静脉肾盂造影、MRI,手术治疗为主。结论:输尿管损伤是妇科腹腔镜手术少见而严重的并发症。我们应警惕妇科腹腔镜手术中输尿管损伤的可能。

Objective ：To investigate the ureteral injury in gynecological laparoscopy and discuss its diagnosis,treatment and prevention.Methods：Ureteral injury in gynecological laparoscopy during the past 8 years was reviewed retrospectively.The methods of diagnosis,treatment and prognosis of ureteral injury were studied.Resuits：There were 8 ureteral injuries （0.22%）in 3654 cases of laparoscopy.The ureteral injuries all occured in la- paroscopieally assisted vaginal hysterectomy （LAVH）,the sites of injury were near the uterine artery, sacrospinous ligament, and entrance of bladder,Patients presented increased vaginal drainage ,flank pain, increased volumes of vaginal discharge, nausea and vomiting,fever and edema. Ureteral injuries were mainly diagnosed via type-B ul- trasonic,cystoscopy examination,intravenouspyelography,and MRI,Surgical repair is the primary treatment.Outcomes were good in all cases.conclusion：Ureteral injury is an uncommon but severe complication in gynecological laparoseopy.We should pay attention to ureteral injury in gynecological laparoscopy.