Outcome of laparoscopic repair of ureteral injury: follow-up of twelve cases

Study ObjectiveTo review the feasibility of laparoscopic repair in cases of ureteral injuries occurring during gynecologic laparoscopy.DesignRetrospective study (Canadian Task Force classification II-3).SettingInstitution-specific retrospective review of data from a tertiary referral medical center.PatientsPatients suffering from iatrogenic ureteral injuries diagnosed during or after surgery, and cases with deliberate ureteral resection and repair because of underlying disease.Measurements and Main ResultsWe conducted a retrospective review of all (10 345) laparoscopic gynecologic surgeries performed in our institute between February 2004 and November 2008. Twelve cases (median: 45.5 years, range: 27–63) of ureter transections were diagnosed and repaired laparoscopically by endoscopists. Of these, 10 had previous surgeries, pelvic adhesions, or a large pelvic-abdominal mass. One patient had undergone a segmental resection and laparoscopic ureteroureterostomy for deep infiltrative endometriosis. Of the remaining 11 iatrogenic ureteral transections, 10 were repaired via laparoscopic ureteroureterostomy, whereas 1 had undergone a laparoscopic ureteroneocystostomy. One injury was recognized on the second postoperative day, but intraoperative recognition was attained in 11 cases. The median duration of double J stenting was 73 days. Three patients had development of strictures (between 42 and 79 days after surgery) treated with restenting, but 1 had to undergo an ureteroneocystostomy for ureter disruption when trying to restent. One patient had development of leakage of the anastomotic site but recovered with a change of the double J stent. Only 1 case required another laparotomy for ureteroneocystostomy. Laparoscopic primary repair of ureteral injury was successful for 11 of 12 patients. All the patients were well and symptom free at the conclusion of the study period.ConclusionEarly recognition and treatment of ureteral injuries are important to prevent morbidity. Laparoscopic ureteroureterostomy could be considered in transections of the ureter where technical expertise is available. To the best of our knowledge, this is the largest series, to date, of ureteral repairs via laparoscopy.     

妇科腹腔镜手术中输尿管损伤的临床特点及处理

目的探讨妇科腹腔镜手术中输尿管损伤的主要原因及诊断、治疗和预防的方法。方法回顾性分析我院13年间,妇科腹腔镜手术中发生输尿管损伤患者的临床资料、疾病类型、盆腔情况、手术类型、损伤特点、诊治情况及预后。结果．5541例妇科腹腔镜手术中,共发生输尿管损伤8例,发生率为0．14％,其中腹腔镜辅助阴式子宫切除术(LAVH)发生输尿管损伤6例,腹腔镜下全子宫切除术(TLH)1例,盆腔侧壁粘连松解手术1例。主要妇科疾病为：子宫腺肌症、子宫内膜异位症、子宫肌瘤;8例均有盆腔粘连,4例有盆腹腔手术史,7例子宫手术者,子宫均有增大(6～10周)。输卵管损伤症状出现于术后0～13d,包括：引流量增多、腹痛或腹胀、腰疼、恶心呕吐、发热、尿量减少、阴道流水、腹部皮下水肿、腹膜炎等。诊断时间在术后0～17d,主要确诊方法为静脉肾盂造影。损伤位于输尿管下段6例,入盆腔段2例。2例早期发现者均行开腹手术修补,晚期发现者,2例输尿管置管成功,3例置管当时失败,1例置管后又出现尿瘘行开腹修补。预后均较好。结论输尿管损伤是妇科腹腔镜手术少见而严重的并发症。术后引流量的异常增多以及出现发热、腰腹痛、急腹症、阴道流水等症状时,应警惕输尿管损伤的可能。治疗以手术为主。     

Laparoscopic repair of ureteral injuries

STUDY OBJECTIVES: To evaluate the laparoscopic approach for repairing ureteral injuries, and assess the effect of ureteral dissection (ureterolysis) on tissue healing. DESIGN: Randomized animal study (Canadian Task Force classification I). SETTING: Biological Resources Unit, Cleveland Clinic Foundation. SUBJECTS: Ten pigs. INTERVENTION: In all animals, the pelvic segment of the right ureter was completely dissected off the pelvic sidewall and peritoneum. In group A, both pelvic ureters were divided with scissors and repaired over a stent; in group B the ureters were coagulated and anastomosis was performed after resection of the necrotic segment. Laparoscopic intracorporeal suturing techniques were used for end-to-end ureteral anastomosis. MEASUREMENTS AND MAIN RESULTS: All animals survived without complications. Ureteral stents were removed 4 weeks after repair. Creatinine level and retrograde pyelogram performed before injury and 12 weeks after repair were compared. At necropsy anastomoses were evaluated for leak, pressure flow studies, and histopathology. All anastomoses were patent with no leak. Although serum creatinine level increased significantly after repair (p = 0.001), this increase never reached levels found in renal failure, and all animals continued to do well and have good appetite (mean increase in body weight 20.3 +/- 6.2 kg). Mild hydronephrosis was diagnosed in three kidneys, all on the right side. Mild ureteral dilatation occurred bilaterally; it was significant on the right side (3.8 +/- 3.8 mm, p = 0.05) but not on the left (1.7 +/- 2 mm, p = 0.3). Results of pressure flow studies did not reveal significant obstruction at anastomoses. Healing around the dissected right ureter was marked with dense fibrosis, adhesions, and scar formation. On histopathology the right ureter showed more urothelial abnormalities than the left, with marked fibrosis and sclerosis in the muscularis and adventitial layers. CONCLUSION: Ureterolysis may interfere with the healing process of ureteral injuries by increasing fibrosis and adventitial scarring. Laparoscopic repair of these injuries is feasible and safe.     

Can centralised care of complex laparoscopic procedures prevent urinary tract injuries?

Centralised care of complex laparoscopic procedures offers expertise and multidisciplinary care. The objective was to identify if centralised care makes urinary tract injuries less likely or avoidable. This Retrospective Audit was performed at a Tertiary Referral Centre for Advanced Laparoscopic Surgery in North East England. The incidence of injury to bladder/ureter, time of diagnosis, instrument, location, side and mode of repair were evaluated in 105 consecutive complex laparoscopic procedures. Injuries were identified in three (2.8%) cases. There was one bladder injury which was unavoidable. The bladder dome was opened to allow excision of bladder endometriosis. There were two ureter injuries. The first injury involved the ureter being locked in a vaginal vault stitch. The second injury had stage IV endometriosis with peri-ureteric endometriosis where the anatomy was distorted, with medial displacement and kinking of the ureter secondary to fibrosis at the level of the ureter crossing below the uterine artery, with resultant accidental transection of the ureter close to the uterine artery. The first ureter injury was not a laparoscopic injury but due to vaginal vault closure. Arguably, vault closure in any vaginal hysterectomy could carry the same theoretical risk. The only direct laparoscopic injury was the ureteral transection. Such cases present a challenge due to a higher chance of anatomical distortion and predisposition to urinary tract injury. Noteworthy here is the fact that the ureter injury occurred where there was probable distortion of the anatomy, due to endometriosis, of the ureter at the level of the uterine artery. These cases are tackled by experienced laparoscopic surgeons in tertiary centres, yet injuries still occur. Is it possible then that those injuries represent a minimum unavoidable injury rate, and are they injuries or in fact unavoidable consequences of such inherently dangerous and difficult surgery?     

妇科腹腔镜手术泌尿系损伤的临床分析

目的：探讨妇科腹腔镜手术发生泌尿系损伤的相关因素、诊断、治疗方法及预防措施。方法：回顾分析2002年1月至2012年12月北京大学人民医院妇科腹腔镜手术发生泌尿系损伤患者的临床资料。总结分析患者的疾病类型、手术方式、损伤特点、诊疗情况及预后等。结果：妇科腹腔镜手术共4773例,泌尿系损伤发生18例（0.38％）,其中8例发生于腹腔镜恶性肿瘤手术,8例发生于腹腔镜辅助阴式全子宫切除术（LAVH）,2例发生于腹腔镜附件手术。18例泌尿系损伤患者中5例有腹部手术史,有腹部手术史者的泌尿系损伤发生率高于无手术史者（P〈0.05）。18例泌尿系损伤患者中膀胱损伤4例,其中3例位于膀胱后壁,1例位于膀胱三角区;输尿管损伤14例,其中输尿管上段损伤2例,中段损伤10例,下段损伤2例;左侧输尿管损伤2例,右侧12例。术中发现损伤10例,其中4例膀胱损伤和6例输尿管损伤;术后发现8例,均为输尿管损伤,于术后1～10天发现,均经静脉肾盂造影确诊。11例经再次手术修补成功,7例放置输尿管支架6个月（3～12个月）保守治疗成功。结论：腹腔镜下恶性肿瘤手术、LAVH、有腹部手术史患者发生泌尿系损伤机率较高,输尿管损伤多于膀胱损伤。术者需高度警惕,术后严密观察,如发现泌尿道损伤,尽早请泌尿科医师共同决定治疗方法。     

Frequency of lower urinary tract injury at laparoscopic burch and paravaginal repair

STUDY OBJECTIVE: To estimate the rate of injury to the lower urinary tract during laparoscopic Burch urethropexy and/or paravaginal repair. DESIGN: Retrospective analysis over 30 consecutive months (Canadian Task Force classification II-2). Setting. Community hospital. PATIENTS: One hundred seventy-one consecutive patients. INTERVENTION: Laparoscopic Burch urethropexy and/or paravaginal repair. MEASUREMENTS AND MAIN RESULTS: All patients had intraoperative transurethral videocystoscopy performed with intravenous injection of indigo carmine dye to assess potential injury to bladder or ureter. Four women (2.3%, CI -0.71-0.03) had injury to the lower urinary tract. All four injuries were cystotomies, two in women with previous open retropubic urethropexy. No ureteral ligation or intravesical placement of suture was diagnosed. CONCLUSION: Despite most patients having both Burch urethropexy and paravaginal repair, the lower urinary tract injury rate of 2.3% is much lower than the reported 10% for patients having Burch urethropexy alone performed by laparotomy. Reported benefits of laparoscopy including less blood loss and better visualization may explain this result.     

Major complications of operative and diagnostic laparoscopy for gynecologic disease

STUDY OBJECTIVE: To compare complication rates of diagnostic and operative laparoscopy. Design. Retrospective study (Canadian Task Force classification II-2). SETTING: One medical center and three teaching hospitals. PATIENTS: Six thousand four hundred fifty-one women with various indications for laparoscopic diagnosis and/or laparoscopic surgery from January 1994 through June 1999. INTERVENTION: Diagnostic and operative laparoscopies. MEASUREMENTS AND MAIN RESULTS: Forty-two major complications occurred that directly resulted in one death. One patient had stomach injury, 3 had major vessel injuries, 5 had ureter injuries, 10 had intestinal injuries, and 23 had bladder injuries. The overall complication rate for all laparoscopies was 0.65% (42/6451); however, it rose to 0.80% (39/4865) for operative laparoscopy compared with 0.19% for diagnostic laparoscopy (3/1586; p <0.001, Fisher's exact test). CONCLUSION: Laparoscopic surgery is appropriate for managing various gynecologic diseases and has an acceptable complication rate. However, operative laparoscopy should be performed carefully because its rate of complications is significantly higher than that of diagnostic laparoscopy, especially for laparoscopic-assisted vaginal hysterectomy. (J Am Assoc Gynecol Laparosc 8(1):68-73, 2001)     

Injury to the ureter during gynecologic surgical procedures

This retrospective study examined ureteral injuries during gynecologic operations from January 1980 to August 1985. The study was conducted at two private hospitals that are involved in resident teaching programs. Each patient was reviewed for predisposing factors, location and type of injury and time and method of recognition. Sixteen injuries were documented in 1,093 extensive procedures. Twelve injuries occurred at the pelvic brim and four others occurred elsewhere in the pelvis. Risk factors included previous surgical procedures in the pelvis, endometriosis, ovarian neoplasm, pelvic adhesions, distorted anatomic features of the pelvis and repair of the bladder. The anatomic structure of the ureter is reviewed, and recommendations are made to help prevent ureteral injury during surgical procedures in the pelvis.     

The routine use of cystoscopy with the Burch procedure

OBJECTIVE: We sought to determine the incidence of unsuspected injury to the lower urinary tract as detected by intraoperative cystoscopy when the Burch procedure is performed. STUDY DESIGN: We reviewed the records of 181 women who underwent pelvic surgery, which included a Burch retropubic urethropexy for genuine stress urinary incontinence, between Jan 1, 1998, and Dec 31, 1999. All patients underwent intraoperative cystoscopy at the completion of the Burch procedure after the administration of intravenous indigo carmine dye. RESULTS: There were 6 (3.3%) injuries to the lower urinary tract. Five of the injuries were cystotomies that had been recognized during operation. One obstructed left ureter was detected by cystoscopy and relieved by the release of left paravaginal repair sutures. No unsuspected injuries that were detected by cystoscopy were attributable to the Burch procedure. CONCLUSIONS: The lower urinary tract injury rate was 3.3%. All but one injury was recognized before cystoscopy. The one injury was attributed to concomitant paravaginal repair and not to the Burch procedure.     

Positive symptom improvement with laparoscopic uterosacral ligament repair for uterine or vaginal vault prolapse: interim results from an active multicenter trial

STUDY OBJECTIVE: To evaluate the use of laparoscopic uterosacral ligament repair for long-term patient symptom improvement in patients with uterine prolapse or posthysterectomy vaginal vault prolapse and to evaluate how laparoscopic instrumentation kits facilitate procedure performance for the surgeon. DESIGN: Nonrandomized, prospective, multicenter case series (Canadian Task Force classification II-2). SETTING: Five clinical sites consisting of 4 community hospitals and 1 university medical center. PATIENTS: Seventy-two patients with stage II or worse uterine prolapse (58%, n = 42) or posthysterectomy vaginal vault prolapse (42%, n = 30). One patient with stage I vaginal vault prolapse was included in the group due to her significant symptoms. INTERVENTIONS: Laparoscopic uterosacral ligament repair was performed on all patients; round ligament truncation was also performed selectively on patients with uterine prolapse. Fifty-seven percent (41 patients) had concomitant pelvic procedures. MEASUREMENTS AND MAIN RESULTS: At 12-month follow-up, Pelvic Organ Prolapse Quantification (POP-Q) scores and patient self-reported symptom scores were significantly improved over baseline after laparoscopic repair of pelvic organ prolapse. Positive mean change in POP-Q score was 14.4 (p = .0003) for uterine prolapse repair and 9.28 (p = .017) for vaginal vault prolapse repair. Positive mean change in total symptom score was 20.36 (p <.0001) for uterine prolapse repair and 11.43 (p = .005) for vaginal vault prolapse repair. Surgeons reported a mean procedure time of 31.6 minutes for uterine prolapse repair and 21.7 minutes for vaginal vault prolapse repair. A mean rating of 7.5 was documented for ease of use for the uterine prolapse kit and 4.1 for the vaginal vault prolapse kit on a scale of 1 to 10. CONCLUSION: Laparoscopic uterosacral ligament repair improves symptoms and POP-Q scores over the long term in patients with uterine or vaginal vault prolapse. Laparoscopic instrumentation kits facilitate procedure performance for the surgeon with expedited surgery times.     

腹腔镜妇科恶性肿瘤淋巴结清扫术中并发症及处理

腹腔镜下的盆腔和腹主动脉旁淋巴结切除术以其干净、彻底、视野暴露充分、出血少而著称,在妇科三大恶性肿瘤的手术中应用的越来越广泛,但其相关并发症尤其是术中静脉的损伤并未减少,补救的方法与传统开腹手术有所不同。腹腔镜手术中出现的静脉损伤绝大多数可在镜下得到及时有效的修补,无需中转开腹进行修补。补救的方法有直接缝合法和止血材料外加后腹膜缝合加压固定法。     

Laparoscopic management of external iliac artery injury using yasargil clamps and intracorporeal suture

Presented is a case report of laparoscopic repair of an external iliac artery injury using titanium Yasargil clamps and intracorporeal suture during lymphadenectomy. Yasargil clamps were introduced and placed, 1 distal and 1 proximal to the lesion. The vascular injury site was identified and repaired using intracorporeal sutures. Laparoscopic staging was completed successfully. No sign of thrombosis or vascular occlusion was detected. The patient was discharged on postoperative day 4 to receive adjuvant therapy. Laparotomy is the accepted way of managing major vascular injuries during laparoscopy. However, in controlled circumstances, with availability of Yasargil clamps and a surgeon experienced with intracorporeal suturing, immediate laparoscopic repair of major vascular injury is feasible and is a safe alternative to open surgical repair.     

Complications of laparoscopic surgery for benign ovarian cysts

STUDY OBJECTIVE: To assess complications of laparoscopic surgery in the management of ovarian cysts. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: University-affiliated hospital. PATIENTS: Consecutive patients (513) undergoing laparoscopic surgery for ovarian cysts not suspected to be malignant. INTERVENTION: Laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS: A total of 587 ovarian cysts were removed from 513 women. Conversion to laparotomy was necessary in five cases (<1%). Mean +/- SD cyst diameter was 5.5+/-2.9 cm, with endometriomas (44. 5%) and dermoids (24.3%) being the two most common pathologies; 6.6% were functional. Mean +/- SD operating time was 69+/-31 minutes, and hospital stay and postoperative convalescence was 2.6+/-1.5 and 14.3 +/-9.6 days, respectively. The overall complication rate was 13.3%. Major complications occurred in three patients (0.6%): one small bowel injury and two ureter injuries. Cannula site complications were five inferior epigastric vessel injuries and four incisional hernias at the 10-mm lateral port site. CONCLUSION: Laparoscopic ovarian surgery was associated with 13.3% complications, with 0.6% being major. Careful patient selection and proper surgical training are critical to ensure safe performance of laparoscopy.     

子宫颈癌患者腹腔镜下广泛子宫切除术联合淋巴结切除术的临床效果评估

目的 评估腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术用于治疗子宫颈癌的临床效果。方法 对57例Ⅰa～Ⅱb期的子宫颈癌患者,施行腹腔镜下广泛子宫切除术联合盆腔及腹主动脉周围淋巴结切除术。其中子宫颈鳞状细胞癌48例,腺癌7例,腺鳞癌2例。结果 除2例外,所有患者均在腹腔镜下完成手术,平均手术时间为186min(150～320min),术中平均出血168ml(120～700ml),切除盆腔和腹主动脉周围淋巴结数量平均为18．6个和8．2个;8例患者淋巴结为阳性。所有切除组织边缘大体检查均为阴性。术中2例膀胱损伤、1例静脉损伤,均于镜下修补成功;2例中转开腹。术后肛门排气时间平均为2．3d,恢复自主排尿时间平均为10．2d。手术后每3个月随访1次,发现轻度输尿管狭窄1例,尿潴留2例,阴道残端复发3例,病情未控1例。结论 腹腔镜下广泛子宫切除术联合盆腹腔淋巴结切除术j治疗子宫颈癌手术创伤小、并发症少、术后恢复快,是一种治疗子宫颈癌的理想方法。     

Ureteral injury after laparoscopic surgery

Ureteral injuries are uncommon but serious complications of laparoscopic pelvic surgery. When unrecognized, patients experience fever, abdominal pain, signs of peritonitis, and leukocytosis usually 48 to 72 hours after the surgical procedure. A 48-year-old woman underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and anterior and posterior colporrhapy due to a large, symptomatic uterine myoma. Postoperatively, she suffered from progressive left lower quadrant pain, with drainage of yellowish fluid from the subumbilical puncture wound 5 days after the operation. Significant urinary ascites was present. Intravenous pyelogram revealed injury to the lower third of the left ureter about 3 cm away from the ureterovesical junction. Leftsided percutaneous nephrostomy was performed after transurethral placement of a ureteral stent failed. Reanastomosis of the ureter was performed successfully 3 months later, and the patient fully recovered without compromise of the genitourinary tract.     

Assessment of laparoscopic injuries by three methods

OBJECTIVE: To compare laparoscopic, gross, and fluorescent assessment of laparoscopic pelvic injuries. DESIGN: Experimental prospective study. SETTING: Cleveland Clinic Foundation Animal Research Laboratory, Cleveland, Ohio. ANIMAL(S): Nonpregnant adult female pigs. INTERVENTION(S): Pelvic organs injured with laparoscopic energy sources were assessed laparoscopically, grossly, and with a fluorescent indicator and Wood's lamp. MAIN OUTCOME MEASURE(S): Three different measurements of each laparoscopic injury. RESULT(S): Assessment of injuries by laparoscopy did not differ significantly from gross assessment of injuries. In the segments of bowel and bladder that were injured with monopolar cautery, the Wood's lamp assessment of the injuries was significantly longer than the laparoscopic assessment of the injuries. CONCLUSION(S): Laparoscopic assessment of injured ureters, bowel, and bladder appear to be similar to gross assessment of these tissues. In tissue where the serosal surface is intact, the use of a fluorescent dye and a Wood's lamp provides a clear margin of the injured tissue.     

Endometriosis: the consequence of uterine denervation–reinnervation

Difficult intrapartum episodes and persistent straining during defecation cause injuries to uterine nerves and uterosacral ligaments. Injuries to uterine nerves (denervation) result in loss of fundocervical polarity, uterotubal dysmotility and retrograde menstruation. Ectopic endometrium, delivered by retrograde menstruation, adheres to injuries to uterosacral ligaments and peritoneal surfaces. Difficult vaginal deliveries result in laparoscopic appearances of asymmetry of uterosacral ligaments with, or without, ectopic endometrium. Straining during defaecation causes the “classic” appearances of nulliparous endometriosis including hypertrophy of the uterosacral ligaments often with large volumes of ectopic endometrium. Laparoscopic appearances depend on the site, nature, extent, and timing of tissue injury, as well as the presence of available endometrium. Tissue repair, including reinnervation in the uterine isthmus, cervix, vagina and uterosacral ligaments, contributes to chronic pelvic pain, dysmenorrhea, dyspareunia and subfertility some time after the primary injuries.     

Management and Outcome of Rectal Injury During Gynecologic Laparoscopic Surgery

ObjectiveTo assess the incidence and management of accidental rectal injury during gynecologic laparoscopic surgery.DesignA retrospective study with review of outcomes (Canadian Task Force classification II-3).SettingA tertiary care/research/university hospital.PatientsPatients with colon injury during laparoscopy for gynecologic diseases at Samsung Medical Center, Seoul, Korea, from January 2000 to April 2012.InterventionUse of absorbable suture or staples in primary repair of injured colon.Measurements and Main ResultsFrom January 2000 to April 2012, 12 354 patients underwent laparoscopic surgery. Rectal injury occurred in 15 women (0.12%). Their median age was 42.5 years (30–49), and the median length of injury was 3 cm (0.7–7). Among 13 patients with rectal injuries recognized during surgery, 10 patient injuries were repaired primarily with interrupted absorbable sutures without converting laparotomy, 1 patient underwent laparoscopic low anterior resection with Endo-GIA, 1 underwent open primary repair, and 1 underwent open low anterior resection. Two rectal injuries were detected after surgery. One of these patients underwent primary repair under laparotomy at day 4 after surgery. The other patient had development of a rectovaginal fistula requiring open segmental resection 30 days after primary laparoscopy despite conservative management, including percutaneous drainage and prophylactic antibiotics.ConclusionRectal injury during laparoscopy in the gynecologic field can be repaired successfully without the need for a colostomy regardless of mechanism of injury and the size of injury if adequate rectal tissue is available and recognized during surgery.     

腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术23例并发症分析

目的 探讨因宫颈癌及子宫内膜癌行腹腔镜广泛子宫切除术和盆腹腔淋巴结切除术患者的并发症发生情况及防治方法。方法 回顾性分析我院2000年7月至2004年12月间,278例宫颈癌及子宫内膜癌患者的腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术的临床资料。结果 278例腹腔镜广泛子宫切除术及盆腹腔淋巴结切除术中,除4例中转开腹外,其余手术均在腹腔镜下完成,其中有108例患者行腹主动脉周围淋巴结切除术。4例中转开腹手术者中,3例为急诊开腹手术,1例为选择性开腹手术。278例中共发生各类并发症23例,术中并发症13例,其中血管损伤7例,5例在腹腔镜下行血管修补或结扎,1例髂外静脉损伤者开腹行血管吻合术,1例开腹止血;膀胱损伤4例,均在腹腔镜下行修补术;1例患者因高碳酸血症中转开腹手术;另1例患者因结肠损伤而中转开腹行肠修补术。术后并发症10例,其中3例输尿管阴道瘘,3例膀胱阴道瘘,需再次手术治疗;1例输尿管狭窄;3例尿潴留。结论 腹腔镜广泛子宫切除术及盆腔、腹主动脉周围淋巴结切除术正在逐渐成为妇科的常规手术,其最常见的并发症是血管损伤和膀胱损伤。     

妇产科盆腔手术中输尿管损伤96例分析

目的 :探讨妇产科盆腔手术中减少及避免输尿管损伤的措施。方法 :回顾分析妇产科盆腔手术所致输尿管损伤 96例的临床资料。结果 :术中及时发现和术后 4 8h内明确诊断 5 6例 ,均Ⅰ期修复成功 ;术后延迟诊断明确 4 0例 ,除 2例行肾切除术、1例死亡外 ,37例经暂时性尿流改道后 ,Ⅱ期修复成功。结论 :手术野渗液多 ,输尿管扩张 ,术后腰腹疼痛 ,不明原因发热伴切口渗液 ,无尿或腹腔积液等应考虑输尿管损伤的可能。术前充分准备 ,进行相关检查 ,术中分清解剖关系 ,细心操作 ,术后密切观察是防治输尿管损伤的关键