经腹腹腔镜技术早期处理妇产科手术输尿管损伤36例

Transperitoneal Laparoscopy in the Early Treatment of Ureteral Injury in Obstetric and Gynecological Surgery:Report of 36 Cases

目的探讨经腹腹腔镜技术早期(术中或术后2周内)处理妇产科手术输尿管损伤的临床疗效。方法回顾性分析2013年1月~2021年1月36例妇产科手术输尿管损伤的临床资料。术中发现同期处理3例;术后延迟诊断33例,其中7例术后第3天再次手术,26例术后3天~2周手术。10例行输尿管端端吻合,26例行输尿管膀胱再植术。结果36例均为输尿管下段损伤,输尿管离断19例,结扎8例,穿孔2例,烧灼伤7例。术中髂血管损伤2例,无肠管损伤。术后输尿管吻合口漏尿3例,阴道漏尿1例,保守治疗治愈。术后均随访6个月。2例术后轻度肾积水,复查彩超肾积水无加重,行ECT肾显像均提示输尿管排泄无受阻。结论经腹腹腔镜技术早期处理妇产科手术输尿管损伤的疗效确切,安全可行。

Objective To investigate the clinical efficacy of transperitoneal laparoscopy in the early treatment of ureteral injury in obstetric and gynecological surgery.Methods From January 2013 to January 2021,clinical data of 36 patients with ureteral injury in obstetric and gynecological surgery were retrospectively analyzed.Three cases were found and treated in obstetric and gynecological surgery.There were 33 cases of delayed diagnosis after obstetric and gynecological surgery,of which 7 cases underwent re-operation on the third day after obstetric and gynecological surgery,and 26 cases underwent operation from 3 days to 2 weeks after obstetric and gynecological surgery.10 cases underwent end-to-end ureteral anastomosis and 26 cases underwent ureterovesical re-implantation.Results All the 36 patients had lower ureteral injury,including ureteral dissection in 19 cases,ligation in 8 cases,perforation in 2 cases,and cauterization in 7 cases.Intraoperative iliac vascular injury occurred in 2 cases,and no intestinal injury happened.Three cases of ureteral anastomotic leakage and one case of vaginal leakage were cured by conservative treatment.All the patients were followed up for 6 months.Two cases had mild hydronephrosis after operation,but color ultrasonography showed no aggravation of hydronephrosis and ECT renal imaging showed no obstruction of ureter excretion.Conclusion Transperitoneal laparoscopy in the early treatment of ureteral injury in obstetric and gynecological surgery is effective,safe and feasible.