输尿管插管在预防妇科三、四级腹腔镜手术中输尿管损伤的应用价值

The Application of Ureteral Catheter in Complicated Gynecological Laparoscopic Surgery for the Prevention of Ureteral Injury

目的：探讨输尿管插管在预防妇科三、四级腹腔镜手术中输尿管损伤的应用价值。方法选取2009年1月～2011年11月182例我科三、四级腹腔镜手术182例作为研究组，术前均用膀胱镜放置双侧输尿管导管，然后行腹腔镜手术，术中在输尿管导管指示下手术，术后立即拔除导管。选取同期我科三、四级腹腔镜手术200例作为对照组，术前未行输尿管插管，比较2组患者术后输尿管损伤的发生率。结果研究组双侧输尿管置管成功率98．9％（180/182），无一例损伤输尿管。对照组术后发现输尿管损伤2例，开腹行输尿管修补术并留置双J管，术后2个月治愈；膀胱损伤2例，术中均及时发现，立即请泌尿外科会诊，在泌尿外科大夫的协助下及时行膀胱修补术，术后留置尿管2周治愈。2组并发症发生率无统计学差异（ P＝0．125）。结论在妇科三、四级腹腔镜手术中应用输尿管导管可减少术中输尿管损伤的发生。

Objective To investigate the application of ureteral catheter in complicated gynecological laparoscopic surgery for the prevention of ureteral injury . Methods A total of 182 cases of gynecological laparoscopic surgery performed from January 2009 to November 2011 were selected as study group .Bilateral ureteral catheters were inserted under cystoscopy , and then laparoscopic surgery was performed under the instruction of the catheter .The catheter was immediately removed after the surgery .A total of 200 cases of laparoscopic surgery were selected as control group and preoperative ureteral catheterization was not applied in this group .The incidence rate of ureteral injury was compared between the two groups . Results The success rate of bilateral ureteral catheterization in the study group was 98.9%（180/182）and no ureteral injury occurred .In the control group, ureteral injury was found in 2 cases, which were converted to open surgery for ureter repair and double J stent was retained .The 2 cases recovered 2 months after the surgery.Bladder injury was found in 2 cases during the surgery , which received immediate repair assisted by surgeons from the department of urinary surgery and recovered 2 months after postoperative catheterization . No statistical difference was found in complication rate between the two groups （ P=0.125 ） . Conclusion The application of ureteral catheterization in complicated gynecological laparoscopic surgery can reduce the risk of intraoperative ureteral injury .