医源性输尿管损伤的诊断和治疗

The diagnosis and treatment of iatrogenic ureteral injuries

目的 探讨医源性输尿管损伤的原因、处理和预防。方法 对 1989年 10月至 2 0 0 2年 6月收治的 38例 (4 0侧 )医源性输尿管损伤病例进行回顾性分析。结果 4例行双J管保守治疗 ,7例 (9侧 )行输尿管端端吻合术 ,2 2例行输尿管膀胱再植术 ,2例行膀胱壁瓣输尿管吻合术 ,2例行阑尾代右侧部分输尿管术 ,1例行肾切除术。除 1例行肾切除术外 ,其余 37例 (39侧 ,97.5 % )均获得痊愈。结论 术前、术中了解与熟知输尿管的解剖位置 ,细致、规范的手术操作是预防医源性输尿管损伤的关键 ;一旦确诊为医源性输尿管损伤 。

Objective To discuss the cause, treatment and prevention of iatrogenic ureteral injuries. Methods A total of 38 cases with iatrogenic ureteral injuries were reviewed from 1989 to 2002. Results Conservative treatment (double J tube) was carried out for 4 patients, ureteroureterostomy for 7 patients, ureteroneocystostomy for 22 patients, bladder valve-ureter anastomosis for 2 patients, vermiform appendix-ureter replacement for 2 patients, and nephrectomy for 1 patients. Except 1 treated with nephrectomy, all the others(97.5%) were cured. Conclusion Careful and standardized operation as well as familiarity with the anatomy of ureter before and during surgery are the key to prevention of iatrogenic ureteral injuries. When ureteral injures are detected, they should be treated as early as possible according to practical conditions.