输尿管硬镜致输尿管损伤的原因及处理

Cause and management of ureteral injury caused by ureteroscopy

目的分析输尿管硬镜在治疗输尿管结石术中导致输尿管损伤的原因并探讨其处理措施。方法回顾性分析笔者所在科2011年1月—2014年8月263例输尿管结石行手术治疗的患者临床资料,重点对术中发生输尿管损伤的12例患者的资料进行总结。结果输尿管口损伤6例,黏膜下损伤并假道2例,输尿管穿孔3例,均留置双J管2~4周;输尿管黏膜袖套样剥离1例,改开放性手术治疗,预后良好。结论严格把握输尿管硬镜的手术指征,充分了解输尿管的解剖走向,熟练手术操作技巧,是减少输尿管的医源性损伤的关键,及时发现并正确处理可明显改善患者的预后。

Objective To analyse the causes and management of ureter injury related to ureteroscopy.Methods A retrospective analysis was made on the clinical data of 263 cases who underwent ureteroscopy from Jan. 2011 to Aug. 2014 in author's department. Among the 263 cases 12 subjected to ureteral injuries in the operation were analysed and summarized. Results Among the 12 cases 6 had dilaceration of the ureteral orifice,2 had submucosa injury and false passage,3 had ureteral perforation,the above-mentioned 11 cases were treated with the placement of double J stents for 2-4 weeks,rest 1 had sleeve-like avulsion of the urereral mucosa,then was treated by open-surgery and got good prognosis. Conclusion Strictly mastering surgical indications,be familiar with ureteric dissection and skilled operation are key to decrease the ureteral injury induced by ureteroscopy;timely discovering and right managing the injuries could significantly improve the patient's prognosis.