妇科腹腔镜手术泌尿系统损伤27例临床分析

Clinical Analysis of Urinary Tract Injuries in Gynecologic Laparoscopic Surgery(27 Cases)

目的探讨妇科腹腔镜手术泌尿系统损伤的临床特点和处理。方法回顾性分析2008年1月1日—2017年12月31日在沈阳市妇婴医院妇科腹腔镜手术中发生的27例泌尿系统损伤情况。结果在16 925例妇科腹腔镜手术中,发生泌尿系统损伤27例,发生率为0.16%。其中,输尿管损伤12例,膀胱损伤15例。术中发现损伤23例(占85.2%),另4例于术后发现(占14.8%)。术后发现损伤时间为术后7～27 d,经美蓝实验和(或)膀胱镜检查及静脉肾盂造影,其中3例为输尿管损伤,1例为膀胱损伤。全部27例患者经过及时修补、留置输尿管双J管和(或)持续留置导尿管,全部治愈。结论盆腔粘连严重或病变改变泌尿系统解剖以及手术难度不断增加,是造成腹腔镜手术泌尿系统损伤的重要原因。损伤一旦发生,及早诊断及处理,预后较好。

Objective To discuss the clinical features and treatment of urinary tract injuries in gynecologic laparoscopic surgery.Methods 27 cases of urinary tract injuries in gynecologic laparoscopic surgery were selected in Shenyang Women's and Children's Hospital from January 1,2008 to December 31,2017,which were analyzed by retrospective study.Results In 16 925 cases of gynecological laparoscopic surgery,27 cases of urinary tract injury occurred,the incidence was 0.16%.Among them,there were 12 cases of ureteral injury and 15 cases of bladder injury.23 cases was found in operation(85.2%),and another 4 cases were found postoperation(14.8%).The time of injury was found to be 7~27 days after surgery.3 cases of ureteral injury and 1 case of bladder injury were found by performed routine methylene blue and/or cystoscopy and intravenous renal pelvis examination.All 27 patients were cured after timely repair,retention of double J ducts and/or continuous retention of catheter.Conclusion It is discovered that severe pelvic adhesions or lesions change the anatomy of the urinary system,as well as the increasing difficulty of surgery is the important reasons of causing urinary tract injury in laparoscopic surgery.Once the injury occurs,better prognosis should be achieved through positive diagnosis and symptomatic treatment.