妇科腹腔镜手术泌尿系统损伤8例临床分析

Urinary system injury in gynecological laparoscopic operation in 8 cases

目的探讨妇科腹腔镜手术中发生泌尿系统损伤的原因及治疗方法。方法 3 852例妇科肿瘤患者行妇科腹腔镜手术,其中8例发生泌尿系统损伤,回顾性分析8例患者临床资料。结果 8例中输尿管损伤5例,膀胱损伤3例;3例有盆腹腔手术史,3例盆腹腔严重粘连;3例膀胱损伤于术中腹腔镜下修补后愈合,5例输尿管损伤中1例腹腔镜下行断端输尿管吻合,2例置入输尿管双J管,2例行二次开腹输尿管膀胱植入术,均愈合。结论有盆腹腔手术史及合并盆腔粘连者术中易发生泌尿系统损伤,经腹腔镜或开腹手术均可修复。

Objective To explore the causes and treatment of urinary system injury in gynecological laparoscopic operation. Methods In 3 852 cases of gynecologic tumor undergoing gynecologic laparoscopic surgery, urinary system injury occurred in 8 cases. The clinical data of these 8 cases were retrospectively analyzed. Results In 8 cases of urinary system injury, ureteral injury occurred in 5 cases and bladder injury occurred in 3 cases. Serious abdominal and pelvic adhesion was found in 3 cases and 3 cases had history of abdominal or pelvic operation. Three cases of bladder injury healed after laparoscopic repair. In 5 cases of ureteral injury, 1 recovered after laparoscopic ureteral broken ends anastomosis, 2 cases recovered after uretera[ double-J tube placement, and 2 cases recovered after secondary laparotomy extravesicular ureteral reimplantation. Conclusion Urinary system injury usually occurs in the patients with abdominal operation history or pelvic adhesion, which can be treated by laparoscopy or open surgery.