妇产科盆腔手术中输尿管损伤96例分析

Analysis on 96 cases of iatrogenic ureteral injuries in the pelvic operation.

目的 :探讨妇产科盆腔手术中减少及避免输尿管损伤的措施。方法 :回顾分析妇产科盆腔手术所致输尿管损伤 96例的临床资料。结果 :术中及时发现和术后 4 8h内明确诊断 5 6例 ,均Ⅰ期修复成功 ;术后延迟诊断明确 4 0例 ,除 2例行肾切除术、1例死亡外 ,37例经暂时性尿流改道后 ,Ⅱ期修复成功。结论 :手术野渗液多 ,输尿管扩张 ,术后腰腹疼痛 ,不明原因发热伴切口渗液 ,无尿或腹腔积液等应考虑输尿管损伤的可能。术前充分准备 ,进行相关检查 ,术中分清解剖关系 ,细心操作 。

Objective:To investigate the measures of preventing and avoiding iatrogenic ureteral injuries in the pelvic operation.Methods:Reviewing 96 cases of iatrogenic ureteral injuries occured in pelvic operations.Results: Fifty six cases were identified at operation or within 48 hours after operation and repaired successfully in time.Forty cases were detected after 48 hours postoperatively.Two of them were performed nephrectomy and one died,and others were stented urine temporarily and then repaired successfully. Conclusions:It is possible for iatrogenic ureteral injuries to occur when leakage increased and ureter expanded during operation,urinary leakaging through the wound drainage or having no urine after operation.Immediate recognition of accidental ureteral injury provides optimal results.It is important for preventing iatrogenic ureteral injuries to perform related exmainations before operation,careful operation and intensive observation after operation.