子宫切除术致输尿管或膀胱损伤的手术处理

目的:探讨子宫切除术所致的输尿管、膀胱损伤的手术处理时机。方法:对4例膀胱阴道瘘及5例输尿管阴道瘘中的近期4例,于损伤后2~3周内经腹入路一次修复;先前1例于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例行输尿管皮肤造瘘。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,5例行输尿管膀胱肌瓣吻合,3例行输尿管膀胱再植术。结果:8例损伤后2~3周、1例于损伤后4个月施行膀胱阴道瘘及输尿管道阴道瘘修补术均获成功。3例输尿管离断伤其中直接吻合成功1例、失败1例。1例输尿管、膀胱并发直肠损伤患者经Ⅰ期尿、粪转流,Ⅱ期修补、复通后1年康复出院。8例输尿管梗阻、肾积水患者行输尿管膀胱再植术或输管膀胱吻合术均获成功。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瘘,经腹入路手术修复。

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 were 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 were 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 anastomosisbetween 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:Abdominal surgical procedures for repair of ureteral or bladder injuries during hysterectomy are associated with good outcome,The operating time is 2 or 3 weeks later than 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.