妇科手术致输尿管损伤的一期处理

Early management of ureteral injury caused by gynecological surgeries

目的探讨妇科手术致输尿管损伤一期处理的治疗效果。方法回顾性分析一期处理的11例妇科手术致输尿管损伤患者的临床资料和治疗结果。结果 11例患者,术中发现4例;术后2～10d发现7例,均行膀胱美篮试验,排除膀胱瘘,行膀胱镜下输尿管逆行插管有造影剂外渗,证实为输尿管中、下段瘘。术中发现4例患者均行输尿管端端吻合+双J管置入术;术后发现的7例患者,6例行输尿管端端吻合+双J管置入术,1例行输尿管膀胱黏膜下隧道再植,并留置双J管。11例患者术后住院4～7d,平均5d;术后1～2个月自膀胱内取出双J管,IVU检查示输尿管吻合处通畅,患肾形态、功能正常。目前随访5～27个月,无狭窄等并发症发生。结论对妇科手术致输尿管损伤患者行一期处理临床效果好,可靠,值得推广。

[ Objective ] To explore the therapeutic efficacy of early management of ureteral injury during gyne- cological surgeries. [ Methods ] The clinical data and the results of treatment in 11 patients with ureteral injury dur- ing gynecological surgeries were analyzed retrospectively. [Results] Of 11 cases of ureteral injuries, 4 cases were found during operation and 7 cases at 2-10 days after injury. For 4 patients who were found during operation were treated with end to end ureteral anastomosis. Of 7 cases that were found after injury, 6 cases were treated with end to end ureteral anastomosis and 1 case with ureteroneocystostomy. The hospitalization time after surgery was 4-7 days, average 5 days. The double J stents were removed after 1-2 months and the IVU showed that shape and func- tion of patient kidneys were normal. Following up 5-27 months, no complications such as ureter stenosis occurred. [ Conclusions ] Early ureteral injury repair is feasible, safe, effective and should be extended.