直肠癌手术输尿管损伤原因及处理

直肠癌是最常见的恶性肿瘤之一，由于直肠与输尿管解剖上的毗邻，直肠癌手术中输尿管损伤不可避免。局部进展期直肠癌侵犯输尿管、术前新辅助放化疗导致盆腔粘连水肿、直肠癌复发需要二次手术，以及外科医生对输尿管解剖不熟悉，术中操作不当均可导致输尿管损伤。术中及时发现，立即修复，预后良好。术后超过48 h发现尿瘘应在保护肾脏功能的同时，2～3个月后再手术修补，留置双J管防止局部狭窄。严格遵守TME原则、在骶生殖襞内侧操作，术前放置双J管等可有效预防输尿管的损伤。

Causes and surgical treatment of iatrogenic ureteral injury in rectal cancer operation

Rectal cancer is one of the common malignant tumors .The rectum and mesorectum are very close to the intrapelvic ureter in anatomy .Ureteral injury could often occur during radical resection of rectal carcinoma .The main risk factors of ureteral injury include the invasion of the ureter by locally advanced rectal cancer , the pelvic adhesion and edema after neoadjuvant chemotherapy and the secondary surgeries of recurrence of rectal carcinoma .Iatrogenic ureteral injury often occurred because of the unfamiliar anatomy and misoperation by doctors .If the ureteral injury was found during surgery and was repaired immediately, the prognosis remained good .Urinary fistula found over 48 hours needs to be repaired at 2-3 months after surgery, based on the protection of the kidney ’ s function.Double J stents should be routinely detained for the prevention of local stenosis .Strict compliance of the principles of total mesorectal excision （ TME） , operation close to the medial sacrogenital folds , and preoperative placement of Double J stent could effectively prevent the ureteral injury .