妇科手术并发泌尿系统损伤22例临床分析

An analysis of 22 cases with urinary tract injury related to gynecological surgery

目的分析妇科手术泌尿系统损伤22例的临床特点与处理。方法回顾性分析22例妇科手术泌尿系统损伤的部位、发现时间、术后尿瘘的发生、诊治和预后。结果在8799例妇科手术中,发生泌尿系统损伤22例（0.25%）。其中,输尿管下端损伤15例,膀胱损伤7例。发现泌尿系统损伤时间：术中16例（72.7%）,术后住院期间4例（18.1%）,出院后2例（9.2%）。发生尿瘘5例（22.7%）。均及时实施手术或给予相应的治疗。随访6~18个月,22例均恢复良好,肾功能正常。结论手术是引起泌尿系统医源性损伤的主要因素;及早发现并适当处理,预后一般较好。

Objective To analyze the clinical characteristics and managements of 22 cases with urinary tract injury related to gynecological surgery.Methods The data of the injuried parts,time of finding,occurrence of postoperative urinary fistula,treatment and prognosis were retrospectively analyzed in 22 cases with urinary tract injury related to gynecological surgery.Rseults Of 8799 patients undergoing gynecologic surgery,urinary tract injury occurred in 22 cases with an incidence rate of 0.25%,which included the lower ureteral injury in 15 cases and bladder injury in 7 cases.The diagnosis of urinary tract injury was made intraooperatively in 16 patients,during hospitalization after operation in 4 cases and after discharge in 2 cases.Urinary fistulae occurred in 5 cases.The urinary tract injury was treated timely and properly.The patients recovered well without adverse effect on renal function during a follow-up of 6 to 18 months.Conclusion Gynecological surgery is a major factor for the urinary tract injury.The outcomes are usually well as long as urinary tract injury is diagnosed timely and managed correctly.