摘要
目的：探讨治疗腹腔镜妇科手术后延迟发现的输尿管热损伤安全、有效、微创的方法。方法：回顾分析4例腹腔镜术后发现输尿管损伤患者的临床资料。其中子宫肌腺症2例、宫颈癌1例、卵巢子宫内膜异位囊肿1例。分别行腹腔镜下全子宫切除、宫颈癌根治、卵巢囊肿切除术。于术后第8天、第8天、第16天、第10天确诊输尿管热损伤，输尿管镜下见损伤处位于输尿管开口上1—10cm，局部苍白破渍，输尿管断裂面达1／3～2／3。结果：4例患者中2例放置单根“DJ”管失败后重置双根均获成功；2例直接放置双根“DJ”管成功。4例患者均于置管后3个月拔管，最长随访2年余，无异常。结论：对于延迟发现的腹腔镜妇科手术导致的输尿管热损伤，双根“DJ”管的内支架与引流更充分、不堵塞，可有效预防远期瘢痕狭窄、避免再次手术，是有效的保守治疗方式。
Objective： To investigate the safe, effective and minimally invasive treatment of late diagnosed thermal damage of u- reter caused by gynecological laparoscopy. Methods ： The clinical data of 4 cases of ureteral injury were retrospectively analyzed. 2 cases of adenomyosis, 1 case of cervical cancer and 1 case of ovarian endometriosis cyst were included. Laparoscopic panhysterectomy, laparo- scopic radical operation for cervical cancer and laparoscopic ovariocystectomy were performed respectively. Thermal ureteral injury was diagnosed in the 8 th,8 th, 16 th and 10 th day respectively. Injury was found 1-10 cm above the ureteral opening through ureteroscope. Local appearance was pale and ulcer. Fracture plane of the ureter accounted for 1/3-2/3. Results：Two patients in the 4 cases succeeded in placing two DJ tubes after failure of placing one tube. The other two patients succeeded in placing two DJ tubes directly. Four patients were extubated after 3 months. The longest follow-up visit lasted for more than 2 years and no abnormality was found. Conclusions ： Lap- aroscopic gynecological surgery can lead to the thermal damage of ureter, which is usually found lingeringly. The stent and drainage of two DJ tubes is more effective and not easy to be blocked, which will be effective in preventing the long-term scar stricture and avoiding reoperation. So it is an effective way of conservative treatment.
出处
《腹腔镜外科杂志》
2013年第11期828-830,共3页
Journal of Laparoscopic Surgery
关键词
输尿管热损伤
延迟发现
输尿管支架
妇科外科手术
腹腔镜检查
手术后并发症
Thermal damage of ureter
Late diagnosis
Ureteral stent
Gynecologic surgical procedures
Laparoscopy
Postopera- tive complications
