剖宫产术中输尿管损伤的识别与处理

输尿管损伤是剖宫产重要并发症之一，高危因素有急症剖宫产手术、剖宫产手术史、剖宫产术中子宫切除术、其他盆腹腔手术史以及盆腔感染史。损伤部位多发生在下段输尿管，尤其是距输尿管膀胱连接的1.5～3cm处，左侧多于右侧。术中发现输尿管损伤较困难，术后可通过超声、CT尿路造影（CTU）或逆行肾盂造影等检查诊断。早期发现并及时修复输尿管损伤对预后至关重要，可以避免和减少术后并发症，降低医疗成本。如发现较晚且情况允许，也可在术后6周至3个月行延迟手术。避免剖宫产术中损伤输尿管，关键在于预防，严密观察产程、及时处理产程异常，避免长时间试产后转剖宫产，术中仔细操作，避免损伤输尿管。

Recognition and treatment of ureteral injury in cesarean section.

The ureteral injury is one of the significant complication of cesarean section.High risk factors include emergency caesarean section，history of caesarean section，hysterectomy during cesarean section，history of hypogastric zone operation，pelvic infection，etc.The lower uterine segment，especially 1.5-3cm from UVJ，is the most common injury level，and more injuries occur on the left side than on the right.It is difficult to recognize the ureteral injuries intraoperatively.Postoperative diagnosis can be made by ultrasound，CTU or retrograde pyelography.Early recognition and repair of the ureteral injury are essential to the patient outcome and preventing late complications and reducing the cost.If the injuries are diagnosed postoperatively，the delayed operation can be performed between 6 weeks and 3 months after cesarean section if conditions permitted.The key to avoiding ureteral injury during cesarean section is prevention.This requires us to observe the course of labor closely and handle abnormal labor process in time to avoid emergency caesarean section after long trial.The incidence of ureteral injuries can be reduced by careful operation.