妇科腹腔镜手术输尿管损伤的临床分析

目的 探讨妇科腹腔镜手术中输尿管损伤的原因、诊断和治疗。方法回顾性分析2552例妇科腹腔镜手术中发生输尿管损伤患者的临床资料，包括损伤部位、类型、诊治情况和预后。结果2552例妇科腹腔镜手术共发生输尿管损伤5例，发生率0．19％，均发生于腹腔镜辅助阴式子宫切除术术中。2例输尿管完全横断者，术中经静脉美蓝试验确诊，即行输尿管端-端吻合术；1例输尿管热损伤和2例输尿管阴道瘘者，术后经静脉肾盂造影确诊，前者膀胱镜下输尿管置管，后者行输尿管膀胱再植术：所有患者预后均良好。结论输尿管损伤是妇科腹腔镜手术中少见而严重的并发症，多发生于腹腔镜子宫切除术时。若术中出现腹腔渗液、无尿或术后有不明原因发热、阴道大量流液时，应考虑输尿管损伤的可能，明确诊断后须尽早采取手术治疗。

Clinical Analysis of Ureteral Injury in Gynecologic Laparoscopies

Objective To investigate ureteral injury in gynecological laparoscopies and discuss its diagnostic treatment and prevention. Methods Data of ureteral injury in 2 552 gynecological laparoscopies were reviewed retrospectively. The clinical features of the disease uterine size, pelvic adhesion, operative procedures, location, and type of the lesion, time of recognition, and methods of diagnosis, treatment and prognosis of ureteral injury were analyzed. Results There were 5 ureteral injuries(0.19%) in 2 552 gynecological laparoscopies. All ureteral injuries occured in laparoscopically assisted vaginal hysterectomy(LAVH). Electrocautery was involved in 1, transection occurred in 2 of the 5 cases of ureteral injuries. Two injuries were recognized during operation and repaired intraoperatively. The other injuries were found several days later. Ureteral injuries were mainly diagnosed with an intravenous pyelogram (IVP). One patient received treatment by ureteral catheterization successfully, the others received ureteral repair upon laparotomy(end-to-end anastomosis, ureterocystostomy). The outcomes were good in all cases. Conclusion Ureteral injuryis an uncommon but severe complication in gynecological laparoscopies. Most ureteral injuries occur in laparoscopic hysterectomy. Symptoms like unexplained fever, abnormal vaginal discharge postoperation should be paid to attention and ureteral injury should be considered. Surgical repair is the primary treatment.