CTU在妇科手术后输尿管损伤中的诊断价值

目的:探讨CTU在妇科手术后输尿管损伤中的诊断价值。方法:回顾性分析10例经临床及影像检查确诊为妇科手术后输尿管损伤患者的影像学表现,8例行CT平扫、增强及延迟扫描,2例静脉尿路造影后行CT平扫,延迟时间6min～17h,平均3.41h。结果:10例均见输尿管下段损伤(左右各5例)、对比剂外渗;1例可见肾盂输尿管交界处对比剂外溢。阴道内积液、盆腹腔积液及盆腹腔积液并阴道内对比剂积聚各3例;1例肾周、腹膜后积液及对比剂外溢。5例尿性腹膜炎,4例伤侧输尿管扩张,3例(5个肾)肾轻度积水,1例尿性囊肿,1例腹膜后积尿伴炎症。结论:CTU能够清楚显示输尿管损伤的部位、程度、范围及其与周围组织的关系。

The value of computed tomography urography in the diagnosis of ureteral injury caused by gynecologic surgery

Objective：To study the diagnostic value of computed tomography urography（CTU） in ureteral injury caused by gynecologic surgery.Methods：10 patients of ureter injury caused by gynecologic surgery diagnosed by clinical and imaging manifestations were retrospectively studied.8 patients had plain CT,contrast enhanced and delayed CT scanning.2 patients received plain CT after intravenous urography（IVU）.The mean delayed time of excretory phase was 3.41h（ranged from 6m~17h）.Results：Distal ureteral injury was diagnosed in all 10 patients with left/right side for 5 patients each respectively,manifested as contrast medium extravasation of the ureter.In 1 case,the contrast material was extravasated out of the ureteropelvic junction.Intra-vaginal fluid collection,abdomino-pelvic cavity fluid collection as well as abdomino-pelvic fluid collection in combination with intra-vaginal contrast medium collection were revealed in 3 cases each.Perirenal and retroperitoneal fluid collection with contrast extravasation were seen in 1 case,urine peritonitis in 5 cases,ureter dilation of the injury side in 4 cases and mild hydronephrosis in 3 cases（5 kidneys）.Urinoma and retroperitoneal urine collection with inflammation was showed in 1 case each.Conclusion：The details of ureteral injury including its position,degree,extent and the relationship between ureter and surrounding tissues could be clearly displayed by CTU.