腹腔镜子宫切除术输尿管损伤的预防

Prevention of ureteral injury in laparoscopic hysterectomy

目的:探讨腹腔镜子宫切除术输尿管损伤的原因及预防措施。方法:回顾分析2009年1月至2010年12月6例患者行腹腔镜子宫切除术发生输尿管损伤的临床资料。结果:为337例患者行腹腔镜子宫切除术,包括腹腔镜全子宫切除术及腹腔镜辅助阴式子宫切除术,6例发生输尿管损伤,发生率1.78%。6例均有盆腔粘连,发生于右侧;其中2例为输尿管切断,4例为热损伤导致输尿管漏。手术器械使用不当及处理子宫血管时大块钳夹电凝是腹腔镜手术输尿管损伤的主要原因。结论:盆腔严重粘连患者行腹腔镜子宫切除术应慎重。熟悉器械性能并正确使用,处理子宫血管时避免大块钳夹电凝是预防输尿管损伤的主要措施。

Objective：To study the reasons and preventive measures of ureteral injury in laparoscopic hysterectomy.Methods：The clinical data of 6 patients with ureteral injury who underwent laparoscopic hysterectomy（LH,including total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy） from Jan.2009 to Dec.2010 were analyzed retrospectively.Results：Ureteral injury occurred in 6 cases of 337 LH in two years,with the rate of 1.78%.All 6 cases of ureteral injury had pelvic adhesion and occurred at right ureter.Ureteral break and ureteral fistula by heat injury were 2 and 4 cases respectively.The main reasons of ureteral injury in LH were using instruments incorrectly and coagulating mass tissue in handling with uterine blood vessels.Conclusions：LH must be carefully selected to the patients with severe pelvic adhesion.The key to avoid ureteral injury in LH required all instruments must be mastered and used correctly and do not coagulate massive tissue in dealing with uterine blood vessels.