妇科手术致输尿管损伤24例的临床分析

Clinical analysis of 24 cases of ureteral injuries caused by gynecological operation

摘要:

目的： 总结妇科手术所致输尿管损伤的高危情况及治疗经验。方法： 回顾性分析2014年1月至2020年12月妇科手术致输尿管损伤24例患者的临床资料，总结致输尿管损伤的高危因素及诊治经验。结果： 术中发现损伤患者12例，子宫切除术6例（腹腔镜、开腹各3例），肿瘤细胞减灭术5例，盆腔淋巴结切除术1例；输尿管远端损伤7例，近端和中断损伤5例；输尿管破口缝合5例，端端吻合4例，输尿管膀胱再植3例；修补术后10例输尿管通畅、无扩张积水，2例轻度肾积水/输尿管扩张。术后发现损伤的患者有12例，均接受腹腔镜子宫切除术，损伤部位均在输尿管远端，11例行输尿管膀胱再植，1例行端端吻合，术后9例输尿管通畅、无扩张积水，3例轻度肾积水/输尿管扩张。结论： 子宫切除术、腹腔镜能量器械使用、肿瘤侵犯输尿管、输尿管周围脓肿或粘连是引起输尿管损伤的高危因素；及时发现并及时处理预后良好。

Abstract:

Objective: To summarize high-risk situations and treatment experience of ureteral injuries caused by gynecological operations. Methods: Clinical resources of 24 cases of ureteral injuries caused by gynecological operations from January 2014 to December 2020 were reviewed to summarize high-risk factors and experience of treatment and diagnosis. Results: There were 12 cases of injuries during the operation，6 cases of hysterectomy（3 cases of laparoscopy and 3 cases of laparotomy），5 cases of cytoreductive surgery，and 1 case of pelvic lymphadenectomy；7 cases were found with the ureter far-end injuries，and 5 cases were found with near-end and middle-end injuries；5 cases received the ureter crevasse suture，and 4 cases received the end-to-end anastomosis，and 3 received the ureter bladder replantation. After repair surgery，10 cases were found with smooth ureters and no expansion and effusion，and 2 cases suffered from the mild hydronephrosis and expansion of the ureters. All the 12 cases were found to be injured after the operation，all of them underwent laparoscopic hysterectomy，and all were found with the ureter far-end injuries. And 11 cases received the ureter bladder replantation，1 case received the end-to-end anastomosis，9 cases were found with smooth ureters and no expansion and effusion，and 3 cases suffered from the mild hydronephrosis and expansion of the ureters. Conclusion: The hysterectomy，use of laparoscope energy instruments，tumor’s invasion of ureters，and whether ureters are swollen or adhered to each other are high-risk factors of ureter injuries. Favorable treatment effects can be achieved by immediately discovering and mending.