医原性输尿管膀胱损伤诊治分析  

Clinical analysis of iatrogenic ureteral injury and bladder injury

作　　者：饶大庞[1] 虞海峰[1] 李新德[2] 陈岳兵[2] 竺海波[1] 陈映鹤[1] 何有华[1] 陈镇钏 

机构地区：[1]温州医学院附属第二医院泌尿外科,325000 [2]浙江大学附属邵逸夫医院泌尿外科 [3]苍南县人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2010年第2期96-98,共3页Chinese Journal of Urology

摘　　要：目的探讨医原性输尿管膀胱损伤发生原因及防治方法。方法医原性输尿管膀胱损伤患者47例，男7例，女40例。其中妇产科手术损伤38例、泌尿外科5例、普外科4例。结果术中发现输尿管损伤16例，其中断裂14例，输尿管壁部分撕裂伤2例；行输尿管断端吻合术13例，肾盂输尿管吻合术1例，1例输尿管镜手术引起输尿管穿孔者予终止手术并留置双J管，1例被迫切除肾脏；术后3～7d发现输尿管损伤7例，其中输尿管下段被结扎4例，输尿管阴道瘘3例，均于术后2周内行输尿管下段膀胱再植术。术中发现膀胱损伤19例，膀胱壁不规则撕裂长约1～3cm；行膀胱修补术17例，由腔镜和TVT手术引起膀胱穿孔2例予留置导尿1周；术后1周～1个月发现膀胱阴道瘘5例，均于3个月后行瘘管切除修补术。术后47例随访5个月～11年，平均47个月，患者均治愈，无并发症。结论医原性损伤重在预防，术中及时发现、正确处理可避免二次手术；术后出现尿瘘者选择合理治疗方案可提高治愈率。Objective To investigate the etiology and treatment of iatrogenic ureteral injury（IUI） and bladder injury（IBI）. Methods Forty seven patients（7 males, 40 females） with ureteral and bladder injuries caused as a result of any medical procedures were reviewed from 1996 to 2007. Obstetrics and gynecological, urological,general surgical procedures were involved in 38, 6, and 4 of the injuries respectively. Results Sixteen cases of IUI were found during operation, including 14 cases of entire ureteral laceration, 4 cases of partial ureteral laceration. Thirteen cases received ureteral anastomosis, one case received uretero- neopyelostomy. One case of ureteral perforations during ureteroscopic procedure was indwelled of double-J after the operation was terminated immediately. Three cases received nephrectomy. Four cases of lower ureteric suture ligation and three cases of ureterovaginal fistula were detected at 3 days- one week of postoperation. These 7 cases were received ureteroneocystomy during 2 weeks after the initial surgical procedure. Nineteen cases of IBI were found during operation, the length of cystic wound was ranging from 1 cm to 3 cm. 17 cases underwent repairing, 2 cases of bladder perforation which caused by endourologic or TVT procedure received catheterization for 1 week. Five cases of vesicovaginal fistula which were found during one week--one month of post-operation, were received fistula resection and bladder repairing 3 months after of initial operation. Forty-seven cases were follow-up ranging from 5 months to 11 years after the second operation,mean time were 47 months. All cases were recovered. Conclusions Intraoperative findings and effective treatments can achieve good therapeutic effects and avoid injury during secondary operation. Correct treatment of urinary fistula can promote cure rate.

关 键 词：医原性疾病 输尿管损伤 膀胱损伤 

分 类 号：R699[医药卫生—泌尿科学]