子宫切除术致输尿管或膀胱损伤的手术治疗

目的:探讨子宫切除术所致的输尿管、膀胱损伤的手术处理方法及时机。方法:对4例膀胱阴道瘘及4例输尿管阴道瘘于损伤后2～3周经腹入路一次修复。早期1例输尿管阴道瘘于4个月后修复。3例输尿管离断伤(其中2例为双侧),2例于损伤后第2天直接吻合,1例行输尿管皮肤造口。1例输尿管、膀胱并发直肠损伤患者,Ⅰ期尿、粪转流,Ⅱ期行修补、复通术。8例输尿管梗阻、肾积水患者,于伤后3～32个月行输尿管膀胱肌瓣吻合5例,行输尿管膀胱再植术3例。结果:除输尿管离断伤中直接吻合失败1例,余均获成功。结论:子宫切除术所致输尿管、膀胱损伤的修复手术可提前于损伤后2～3周内施行。输尿管离断伤,应先行输尿管皮肤造口,入路应选择经腹。术式主要根据输管损伤部位距膀胱的长度而定。

Surgical treatment of injury to the ureteror bladder during hysterectomy

Objective:To investigate the selection of operating time and type with injury to the ureter or bladder during hysterectomy.Methods:4 patinents who had resicovaginal fistula underwent onetime abdominal repairs the next 2 or 3 weeks.5 patients had uretero-vaginal fistula.The 4 with later stage were repaired by abdomen also.The early one was repaired after 4 months.In 3 patients who had ureteric transaction(2 with bilateral),2 had end to end anastomosis of ureters the second day and another one had uretero-cutaneous fistulization.A paitent whose ureters,bladder and rectum were damaged had the urine-stool flowing tracts transferred at the primary operation,and repaired and recomalized at the secondary operation.Another 8 patients had ureteral obstruction and hydronephrosis,and suffered operations again during the 3 to 32 months after injury.5 of them were performed an anastomosis between ureter and bladder and bladder muscle flap.3 had ureterocysto-transplantations.Results:Repairs were achieved in 4 patients with ureterovaginal fistula and 5 patienst with vesicovaginal fistula.In 2 patients who had end to end anastomosis of ureteral transactions,one was healed but the other was not well.The patient with lower urinary tract and rectum injured was recovered by transfer and repairs after a year.Conclusions:Abdminal surgical procedures for repair of ureteral or bladder injuries during hysterectomy are associated with good outcome,The operating time is 2 or 3 weeks laterthan injury.Uretero-cutaneous fistulizatiion should be performed in the patient who had ureteric transaction,The type of repair is dependent on the length between the site of injury and the bladder.