摘要
目的:总结38例医源性输尿管损伤的手术方法和治疗经验。方法:回顾性分析2010年1月~2017年12月我院收治的38例医源性输尿管损伤患者的临床资料。38例患者中,妇产科手术损伤15例,泌尿外科16例,普外科7例。术中发现25例,术后发现13例。确诊后均积极进行手术治疗。12例行输尿管镜下留置双J管术,8例行输尿管端端吻合术,6例行输尿管膀胱再植术,4例行输尿管膀胱角吻合术,3例行膀胱壁瓣输尿管吻合术,2例行输尿管松解术,2例先行经皮肾穿刺造瘘术,3个月后改行回肠代输尿管术,1例行患肾切除术。结果:术后平均随访18(6~36)个月,定期行B超、CT、静脉尿路造影等检查,12例输尿管镜下留置双J管术后输尿管狭窄合并中度肾积水5例,行输尿管膀胱再植术后好转;8例输尿管端端吻合术后输尿管狭窄合并中度肾积水2例,行输尿管镜球囊扩张后好转。其余患者患侧输尿管通畅无狭窄,患侧肾无积水。结论:医源性输尿管损伤的处理应根据输尿管损伤情况、患者的具体情况和医生所掌握的技术采用不同的手术治疗方案。复杂性医源性输尿管损伤行输尿管镜留置双J管和输尿管端端吻合术,术后远期输尿管狭窄发生率较高,需要密切随访,必要时进一步处理。
Objective: To summarize the operative methods and treatment experience of 38 cases of iatrogenic ureteral injuries. Method: The clinical data of 38 patients with iatrogenic ureteral injuries treated in our hospital from January 2010 to December 2017 were retrospectively analyzed. Obstetrics and gynecological, urological, general surgical procedures were involved in 15, 16, and 7 of the injuries respectively among 38 patients. Twenty-five cases were found intraoperatively and 13 cases were found postoperatively. Surgical treatment was carried out after diagnosis was confirmed. Twelve patients underwent ureteroscopic double J ureteral stenting, 8 patients underwent ureteroureterostomy, 6 patients underwent ureteroneocystotomy, 4 patients underwent ureteroneocystotomy with psoas hitch, 3 patients underwent ureteroneocystotomy with Boari flap, and 2 patients underwent ureterolysis. Two patients underwent percutaneous nephrostomy first, and then ileal ureteral interposition was applied 3 months later. One patient underwent nephrectomy. Result: All patients were followed up for 6 to 36 months(mean, 18 months). Imaging examinations including B-ultrasonography, CT, intravenous urography were regularly performed. Ureteral stricture with moderate hydronephrosis was found in 5 cases after removal of double J ureteral stents in the ureteroscopic double J stenting group, and ureteroneocystotomy was performed as a correction method. Ureteral stricture with moderate hydronephrosis was found in 2 cases after removal of double J ureteral stents in the ureteroureterostomy group, and improvement was achieved after ureteroscopic balloon dilatation. The affected ureters in the rest cases were unobstructed without stenosis or hydronephrosis. Conclusion: The management of iatrogenic ureteral injury should be based on the specific condition of ureteral injuries, patients’ condition and the surgical techniques mastered by the surgeons. The incidence of ureteral stricture secondary to ureteroscopic double J ureteral stenting and uretero
作者
苏一鸣
卢庆
刘溶
郑怀颖
谢若云
江玮
SU Yiming;LU Qing;LIU Rong;ZHENG Huaiying;XIE Ruoyun;JIANG Wei(Department of Urology,Union Hospital Affiliated to Fujian Medical University,Fuzhou,350001,China)
出处
《临床泌尿外科杂志》
2020年第1期55-58,共4页
Journal of Clinical Urology
