妇科腹腔镜手术泌尿系损伤的临床分析

Clinical Analysis of Urological Injuries during Gynecologic Laparoscopic Surgery

目的总结妇科腹腔镜手术泌尿系损伤的特点。方法收集我院2006年8月至2011年8月614例妇科腹腔镜手术6例泌尿系损伤的临床资料并结合相关文献分析。结果 6例损伤中:膀胱损伤4例(3例发生于分离时,术中及时修补术后愈合好),1例术中未发现,术后1周形成膀胱底壁阴道瘘需开放手术修复;输尿管损伤2例:1例术中及时发现铲形缝合创口后痊愈;1例术中未发现,术后2周表现为输尿管梗阻。结论泌尿系损伤能否早期诊治是决定预后的关键,术中发现损伤并作相应的处理可避免严重不良后果。

Objective To summerize the characters of urological injuries during gynecologic laparoscopic surgery.Methods The clinical data of 6 patients with urological injury during 614 gynecologic laparoscopic surgeries were analyzed and the relevant published literatures were reviewed.Results Among 6 cases of urological injury,there were 4 cases of bladder injury and 2 cases of ureteric injury.3 cases of bladder injury occurred during laparoscopic dissection and were detected and repaired with absorbable sutures with no further urinary complication.One case of bladder injury was not detected during operation and developed into vesicovaginal fistula one week after operation and needed open repair.1 case of ureteric injury was detected and managed during operation and recoverd.The other case was not detected during the operation and ureteral obstruction was developed 2 weeks after operation.Conclusions Early diagnosis and appropriate management of urological injuries during laparoscopic operation is vital to allow prompt repair and limit postoperative morbidity.