膀胱镜检术在妇科腹腔镜手术输尿管损伤预防及早期诊断中的作用

Prevention and early diagnosis of ureteral injury in gynecologic laparoscopic surgery

目的探讨膀胱镜检术及输尿管插管在妇科腹腔镜手术输尿管损伤的预防及早期诊断中的价值。方法回顾中山大学附属第三医院妇科2006年1月至2012年9月期间2542例腹腔镜手术,对复杂病例(18例)及输尿管损伤病例(3例)进行总结分析。结果有7例病例术前检查提示病灶压迫输尿管或考虑盆腔粘连严重,为预防输尿管损伤,手术开始时先行膀胱镜下输尿管置管,结果无一例发生输尿管损伤。11例病例因手术困难,手术结束前进行膀胱镜检查,发现输尿管损伤2例。2542例共发生输尿管损伤3例,其中2例在上述膀胱镜检查中发现,另外1例手术顺利,手术后两周出现腰痛,行静脉肾盂造影发现输尿管损伤。结论输尿管损伤是妇科腹腔镜手术的严重并发症之一,对于复杂病例,手术时行膀胱镜下输尿管置管或膀胱镜检查,能一定程度上预防及早期发现输尿管损伤。

Objective To explore the value of cystoscopy in prevention and early diagnosis of ureteral injury in gynecologic laparoscopic surgery. Methods Between January 2006 and September 2012, three cases of ureteral injury occurred among 2542 gynecologic laparoscopic surgeries in our institution. We analyzed complicated cases and cases of ureteral injury, to find methods of prevention and early diagnosis of ureteral injury. Results Retrograde ureteral catheterization using cystoseopy were performed in 7 patients before operation, whose surgeries were difficult according to preoperative examination. No ureteral injury happened. Postoperative cystoseopy was performed in 11 patients to observe bilateral ureteral orifice＇s movement of urine spurting. Two cases were found with ureteral injury. The other case of ureteral injury was operated smoothly. The patient felt flank pain two weeks after surgery, who was found ureteral injury using intravenous pyelography. Conclusions In difficult gynecologic laparoscopic surgery, retrograde ureteral catheterization and cystoseopy are effective in avoiding ureteral injury.