宫腔镜代替膀胱镜行膀胱内检查及输尿管逆行插管在妇科腹腔镜手术中的应用(附28例分析)  

Cystoscopy and Retrograde Ureteral Catheterization under Hysteroscopy in Gynecologic Laparoscopic Surgery:Analysis of 28 Cases

作　　者：成九梅[1] 段华[1] 刘芸[1] 郭银树[1] 李长东[1] 张颖[1] 马乐[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,北京100006

出　　处：《中国微创外科杂志》2009年第12期1088-1090,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：卫生部行业项目专项基金(项目号:200802071)

摘　　要：目的探讨在妇科腹腔镜手术中,以宫腔镜代替膀胱镜行膀胱内检查及输尿管逆行插管的临床应用价值。方法对19例盆腔病变复杂的妇科腹腔镜手术,在手术前使用宫腔镜代替膀胱镜行输尿管逆行插管;另有9例腹腔镜术后使用宫腔镜代替膀胱镜观察双侧输尿管开口蠕动(喷尿)及膀胱内情况。结果术前行输尿管逆行插管的19例,术中借助导管的定位辨识,避免了输尿管损伤及相关并发症;9例术后宫腔镜代替膀胱镜检查,发现1例左侧输尿管开口蠕动消失,立即腹腔镜探查并拆除该侧输尿管周围组织缝合线,再次置镜观察,输尿管开口蠕动恢复;1例发现膀胱内菜花状新生物,定位活检病理回报为膀胱移行细胞癌,转泌尿外科诊治。28例术后肉眼血尿时间16～42h,无泌尿系感染及相关并发症发生。结论在妇科困难腹腔镜手术中,以宫腔镜代替膀胱镜进行膀胱内检查及输尿管逆行插管,能够降低和及时发现输尿管损伤,是预防妇科腹腔镜手术中输尿管损伤并发症的有效措施。Objective To investigate the clinical value of hysteroscopy replacing cystoscopy in bladder examination and retrograde ureteral catheterization in gynecologic laparoscopic surgery.Methods Retrograde catheterization of the ureter using hysteroscopy instead of cystoscope was done on 19 patients,whose surgery was difficult according to preoperative estimation.Postoperative cystoscopy using hysteroscopy instead of cystoscope was made on 9 patients,with intravenous injection of indigo carmine to observe bilateral ureteral orifice＇s movement of urine spurting.Results No intraoperative ureter injury and other complications occurred in the 19 patients after retrograde catheterization of the ureter.The ureter catheter was removed after the operation.In the 9 patients received cystoscopy,left ureter movement of spurting urine disappeared in one case due to ligation of the lateral ureter,the movement was then recovered after the sutures were removed;Cauliflower-like bladder neoplasm was found in another patient under cystoscope,biopsy then suggested transitional cell carcinoma.The patient was send to urology department for further treatment.Postoperative gross hematuria was revealed in all the 28 cases and was cured spontaneously in 16 to 42 hours.No complications of the urological system were found in the cases.Conclusion In difficult gynecologic laparoscopic surgery,cystoscopy and retrograde ureteral catheterization by hysteroscopy are effective ways to avoid ureteral injury.

关 键 词：宫腔镜 膀胱镜 腹腔镜手术 输尿管逆行插管 

分 类 号：R713[医药卫生—妇产科学]