医源性输尿管损伤

The iatrogenic ureteral injuries

目的 探讨医源性输尿管损伤的原因、类型、处理和预防。方法 回顾性分析了 11例医源性输尿管损伤的临床资料。治疗方法为输尿管逆行内支架管插管引流 2例 ;输尿管修补术 1例 ;输尿管端端吻合术 6例 ;膀胱瓣管法输尿管再吻合术 2例。结果 1例肾积水 ,余肾功能均正常。结论 医源性输尿管损伤的早期与后期诊断有所不同 ,治疗要达到恢复排尿通路和肾功能两个目的。熟悉局部解剖 ,细致规范手术是预防医源性输尿管损伤的关键。

Objective To discuss the cause,type,diagnosis,treatment and precaution of iatrogenic ureteral injuries (IUI). Methods The clinical data of 11 patient with IUI in our hospital were analyzed retrospectively. Two cases had injuries which occurred abdominal surgery, 5 cases with gynecological operation, 2 cases with ureteroscopy. Types of injury included ligation, crush, laceration and avulsion. Eight cases were found during operation time and the diagnosis of the rest 3 cases was established readily on the history. Results Ureteroureterostomy was carried out on 6 patients, uretero neocystostomy on 2 patients, and conservation cure (double J tube) on 2 patient. Repair of ureter was done 1 in patient, and 10 patients were cured. Conclusion Careful and accurate operation as well as familiarity with the anatomy of ureter before and during surgery is the key to prevention of IUI.