输尿管镜下碎石取石术严重输尿管损伤的预防及处理（附5例报告）

本文报道2002年3月～2010年12月行输尿管镜碎石手术出现输尿管断裂、离断及输尿管动脉损伤引起腹膜后大血肿等严重并发症5例。2例输尿管中段断裂,行输尿管端端吻合术;1例输尿管下段断裂,行输尿管膀胱再植术;1例输尿管动脉断裂致腹膜后大血肿形成,行血肿清除＋输尿管动脉结扎术;1例输尿管上段至末端离断伤,行行回肠代输尿管术。分析发生原因,为进镜退镜动作粗暴导致输尿管损伤,或视野不清的情况下继续操作所致。

Prevention and Management of Severe Injury to the Ureter Caused by Ureteroscopic Lithotripsy:Report of 5 Cases

Since March 2002 to December 2010,severe complications,including ureteral rupture or tear,as well as retroperitoneal hematoma caused by the injury to the ureter,occurred in 5 patients.End-to-end anastomosis was carried out in two patients,who had middle ureteral rupture;the other three underwent reimplantation of the bladder and ureter,hematoma clearance plus ligation of the ureteral arteries,and ileal ureter replacement,respectively,for lower ureteral rupture,huge retroperitoneal hematoma caused by ureteral rupture,or a whole ureteral rupture.We believe that the injuries were caused by rough manipulation with ureteroscope or operating in an unclear surgical filed.