输尿管镜手术致输尿管损伤的处理及预防

目的探讨输尿管镜手术致输尿管损伤的原因及治疗和预防措施。方法回顾我院2004年1月～2009年10月所行的1490例输尿管镜手术,对有输尿管损伤的72例进行总结,分析输尿管损伤的原因,总结输尿管损伤的处理经验,提出预防措施。结果1490例输尿管镜手术共有72例(4.83%)发生输尿管损伤,其中,输尿管口严重撕裂25例(1.68%),输尿管穿孔22例(1.48%),假道形成3例(0.20%),输尿管黏膜袖状剥离19例(1.28%),输尿管全层撕脱2例(0.13%),输尿管套叠1例(0.07%)。输尿管损伤患者留置双J管保守治疗68例,开放手术4例。结论正确的输尿管镜操作方法、充分认识输尿管镜手术致输尿管损伤发生的原因、不断提高操作技巧可减少对输尿管的损伤。出现损伤后应及时发现并妥善处理。

Treatment and prevention of ureteral injury caused by ureteroscopy

Objective To summarize the cause, treatment and prevention of ureteral injury caused by uret- eroscopy. Methods Data on 1 490 patients who underwent ureteroscopy from Jan. 2004 to Oct. 2009 in our hospi- tal were retrospectively reviewed. Results Totally 72 patients （4.83%） had ureteral injuries,of whom,25 cases （ 1.68% ） had severe dilaceration of the ureteral orifice,22 cases （ 1.48% } ureteral perforation,3 cases [0.20% ） false passage, 19 cases （ 1.28% } sleeve-like avulsion of the ureteral mucosa ,2 cases（0.13 % ） complete avulsion of the ureter and 1 case （0.07%） ureteral intussusceptions. Sixty-eight patients were treated by indwelling double J stents and 4 patients by open surgery. Conclusion Correct performance of ureteroscope, sufficient recognition of the cause of ureteral injury and skilled operation can decrease the injuries to the ureter. Proper and prompt treat- ment is also important if injury occurs.