医原性输尿管膀胱损伤诊治分析

目的 探讨医原性输尿管膀胱损伤发生原因及防治方法.方法 医原性输尿管膀胱损伤患者47例,男7例,女40例.其中妇产科手术损伤38例、泌尿外科5例、普外科4例. 结果 术中发现输尿管损伤16例,其中断裂14例,输尿管壁部分撕裂伤2例;行输尿管断端吻合术13例,肾盂输尿管吻合术1例,1例输尿管镜手术引起输尿管穿孔者予终止手术并留置双J管,1例被迫切除肾脏;术后3～7 d发现输尿管损伤7例,其中输尿管下段被结扎4例.输尿管阴道瘘3例,均于术后2周内行输尿管下段膀胱再植术.术中发现膀胱损伤19例,膀胱壁不规则撕裂长约1～3 cm;行膀胱修补术17例,由腔镜和TVT手术引起膀胱穿孔2例予留置导尿1周;术后1周～1个月发现膀胱阴道瘘5例,均于3个月后行瘘管切除修补术.术后47例随访5个月～11年,平均47个月,患者均治愈,无并发症. 结论 医原性损伤重在预防,术中及时发现、正确处理可避免二次手术;术后出现尿瘘者选择合理治疗方案可提高治愈率.

Clinical analysis of iatrogenic ureteral injury and bladder injury

Objective To investigate the etiology and treatment of iatrogenic ureteral injury(IUI) and bladder injury(IBI). Methods Forty-seven patients(7 males, 40 females) with ureteral and bladder inju-ries caused as a result of any medical procedures were reviewed from 1996 to 2007. Obstetrics and gynecolog-ical, urological,general surgical procedures were involved in 38, 6, and 4 of the injuries respectively. Re-sults Sixteen cases of IUI were found during operation, including 14 cases of entire ureteral laceration, 4 cases of partial ureteral laceration. Thirteen cases received ureteral anastomosis, one case received uretero-neopyelostomy. One case of ureteral perforations during ureteroscopic procedure was indweUed of double-J after the operation was terminated immediately. Three cases received nephrectomy. Four cases of lower ure-teric suture ligation and three cases of ureterovaginal fistula were detected at 3 days～ one week of postopera-tion. These 7 cases were received ureteroneocystomy during 2 weeks after the initial surgical procedure. Nineteen cases of IBI were found during operation, the length of cystic wound was ranging from 1 cm to 3 cm. 17 cases underwent repairing, 2 eases of bladder perforation which caused by endourologic or TVT procedure received catheterization for 1 week. Five cases of vesicovaginal fistula which were found during one week--one month of post-operation, were received fistula resection and bladder repairing 3 months after of initial operation. Forty-seven cases were follow-up ranging from 5 months to 11 years after the second opera-tion,mean time were 47 months. All cases were recovered. Conclusions Intraoperative findings and effec-tive treatments can achieve good therapeutic effects and avoid injury during secondary operation. Correct treatment of urinary fistula can promote cure rate.