【摘要】 目的:分析医源性输尿管损伤的特点,总结医源性输尿管损伤的诊断和治疗经验。方法:回顾性分析1997年1月-2006年2月间收治的58例医源性输尿管损伤患者的致伤原因、治疗时间、方法和效果。结果:58例患者中,妇产科、普通外科手术致伤者分别为52例(90%)和6例(10%)。损伤方式为结扎、缝扎、离断、缺血性坏死,分别为18例、25例、9例和6例。术中发现8例,术后1-3天发现6例,术后4天-1个月内发现29例,术后3个月以上诊治发现15例。损伤后4周内手术者43例,术式包括松解结(缝)扎线9例,输尿管端端吻合17例,输尿管膀胱再植14例,Boari膀胱肌瓣输尿管吻合3例,随访3-24个月,除1例先前有放射治疗史者出现尿外渗外,余42例无肾积水或肾积水减轻;损伤后3个月以上诊治者15例,因严重肾积水行肾切除2例,输尿管膀胱再植8例,Boari膀胱肌瓣输尿管吻合5例,随访示2例出现肾萎缩,余11例肾积水减轻。结论:对医源性输尿管损伤患者,只要无严重感染或放射治疗史,损伤后1个月内早期修复能取得良好治疗效果。更多还原

【Abstract】 Objective:To analyze the characteristics of iatrogenic ureteral injury and summarize the experiences in diagnosis and treatment of iatrogenic ureteral injury.Methods:From January 1997 to February 2006,the injury causes,the treatment time,the methods of surgical procedures and the results of treatment in 58 patients with iatrogenic ureteral injury were analyzed restropectively.Results:Of 58 cases of iatrogenic urethral injuries,gynecological and general surgical resulted in ureteral injuries in 52 cases(90%) and 6 cases(10%).The main injury causes were ligation,suture ligation,complete transection and ischemic necrosis,the number were 18 cases,25 case,9 cases and 6 cases respectively.8 cases were found during operation,6 cases at 1～3 days after injury,29 cases at 4～30 days after injury and 15 cases were diagnosised over 3 months after injury.For 43 patients who were treated in 4 weeks after injury,treatment methods include ureteral suture lysis in 9 cases,end to end ureteral anastomosis in 17 cases,ureteroneocystostomy in 14 cases,Boari flap in 3 cases.Following up 3～24 months,One patient who has radiopraxis history was diagnosised with urinary extravasation.Hydronephrosis were relieved or no hydronephrosis in 42 cases.For 15 cases who were diagnosised over 3 months after injury,treatment methods include nephrectomy in 2 cases,uretoeroneocystosyomy in 8 cases,Boari flap in 5 cases.Renal atrophy existed in 2 cases,hydronephrosis were relieved in 11 cases.Conclusions:For iatrogenic ureteral injury patients,if no serious infection or radiopraxs history,early repair in one month can acheive good therapeutic effects.更多还原