妇产科手术术前逆行置输尿管导管预防输尿管损伤的临床分析

Clinical analysis of retrograde placement of ureteral catheter before gynecological and obstetrical surgery in the prevention of ureteral injury

目的探讨妇产科较复杂手术术前采用逆行置输尿管导管预防输尿管损伤的方法。方法选取我院2008年6月~2014年6月在妇产科行逆行置输尿管导管手术的96例患者作为研究组,随机选择同期妇产科手术术前未预置输尿管导管76例患者为对照组,宫颈癌手术32例,子宫内膜异位症25例,盆腔二次手术19例。比较两组手术时间、术中出血量、输尿管损伤等并发症相关指标。结果术前采用逆行置输尿管导管组,全部患者未出现输尿管瘘,无输尿管损伤,与对照组比较,差异有统计学意义（P〈0.05）;手术时间较对照组短,术中出血量较对照组少,差异有统计学意义（P〈0.05）。结论妇产科较复杂及较易损伤输尿管手术,术前先采用逆行置输尿管导管,可作为辨认输尿管的标志,对预防损伤输尿管确切有效、安全,有利于缩短手术时间。

Objective To explore the method of application of retrograde placement of ureteral catheter before compli-cated gynecological and obstetrical surgery in the prevention of ureteral injury. Methods Application of retrograde placement of ureteral catheter before gynecological and obstetrical surgery in our hospital from June 2008 to June 2014 was retrospectively analyzed.92 patients received gynecological surgery and 4 patients received obstetrical surgery.The total of 96 patients were selected as the research group;76 patients who did not receive the placement of ureteral catheter before the gynecological and obstetrical surgery at the same period of time were randomly selected as control group,including 32 patients who received surgery of cervical cancer,25 patients with endometriosis and 19 patients who received secondary pelvic surgery.Related indices of surgical time,volume of bleeding,ureteral injury and other compli-cations were compared between two groups. Results In the group who received retrograde placement of ureteral catheter before the surgery,all patients did not show ureteral fistula or ureteral injury,and there was a statistical significance compared with control group （P〈0.05）;the surgical time in research group was shorter than that of control group,and the volume of bleeding was smaller than that of control group,with statistical difference （P〈0.05）. Conclusion For gyneco-logical and obstetrical surgery which is complicated and easy to cause ureteral injury,retrograde placement of ureteral catheter applied before the surgery is able to be taken as a symbol of recognizing the ureter,which is exact,effective and safe in preventing ureteral injury and is beneficial to shorten the surgical time.