局部进展期直肠癌术中输尿管损伤的防治  

Prevention and Management of Intra-operative Ureteral Injury in Local Advanced Rectal Carcinoma

作　　者：欧阳军[1] 李汉贤[1] 黄韬[1] 段有军[1] 

机构地区：[1]南华大学附属第一医院肿瘤外科,衡阳421001

出　　处：《中国现代手术学杂志》2007年第3期175-176,共2页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨局部进展期直肠癌术中输尿管损伤的防治方法和经验。方法局部进展期直肠癌患者52例,麻醉后放置输尿管导管作引导。9例10侧输尿管下段受侵者,切除受侵部分后行修复手术;1例术中检查时发现输尿管损伤,予切除受损伤部分端-端吻合。结果全组肿瘤切除率94.2%(49/52)。随访2年,远处转移率17.3%(9/52),2年生存率76.9%(40/52)。在49例肿瘤切除患者中,27例(55.1%)盆腔复发。9例切除输尿管受侵段者,3例输尿管再次受侵梗阻。结论对于怀疑输尿管受累的局部进展期直肠癌,手术开始时应经膀胱镜留置输尿管导管,尽可能联合切除输尿管的受侵段并一期修复。Objective To study the experiences of prevention and management for intra-operative ureteral injury in local advanced rectal carcinoma. Methods 52 cases of local advanced rectal carcinoma were analyzed retrospectively. Ureteral catheters were placed as guidance in operation. 9 cases （ 10 sides） of invaded ureteral inferior segments and 1 case（ 1 side） of clamped and ligated ureteral segment were ＇removed and repaired. Results The tumor excision rate was 94.2% （49/52）. All cases were followed up for 2 years, the distal metastasis rate was 17, 3% （9/52）, and the 2-year survival rate was 76.9% （40/52）. In the 49 cases of total excision, 27 （ 55.1% ） cases occurred pelvic cavity relapse. In the 9 cases underwent invaded ureteral resection, 3 cases were re-obstructed. Conclusions Ureteral catheters could be placed as guidance in local advanced rectal carcinoma. Invaded ureteral resection and repairing should be performed as possible.

关 键 词：直肠肿瘤 输尿管 创伤和损伤 

分 类 号：R735.37[医药卫生—肿瘤]