直肠癌手术中输尿管损伤的预防措施

尿管创伤多为医源性,多发生于外科手术操作中．尤其是盆腔和腹膜后的手术,结肠和直肠手术导致输尿管创伤占10％。解剖关系的不清晰是导致输尿管损伤的主要原因。输尿管损伤的类型有挫伤、钳夹伤、结扎伤、电刀烧伤、离断或切开伤和扭曲牵拉成锐角等．损伤部位主要在输尿管下段。术前充分评估输尿管损伤的风险、熟悉输尿管的正常解剖以及在病理情况下辨认迂曲变形的输尿管、辩证使用“冷热兵器”并进行合理干预和经膀胱镜留置输尿管导管．是预防输尿管损伤的主要措施和有效方法：一期修复是治疗输尿管损伤的最佳选择。

Measures to prevent ureteric injury in rectal cancer surgery

The majority of ureteric injury is iatrogenic during surgical procedures especially pelvic and retroperitoneal operations. Approximately 10% of ureteric injury is associated with colorectal procedures. The major cause is anatomical anomaly. The types of injuries mainly include contusion, clamp injury, ligation injury, cautery, cut injury and distorted traction to an acute angle. The injuries are mainly located in the lower segment of the ureter. An accurate evaluation of the risk of ureteric injury before rectal cancer operation, a better understanding of anatomy in both normal and abnormal conditions, and ureteral stent placement, are important methods to prevent ureteric injury. Primary repair is the best treatment option.