妇科手术中泌尿系损伤9例临床分析  

Clinical analysis of urinary tract injury in gynecologic surgeries: Nine cases report

作　　者：杨越波[1] 曾海涛[1] 陈静[1] 

机构地区：[1]广州中山大学附属第三医院妇科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2011年第6期51-54,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨妇科手术中泌尿系损伤的易发因素、临床特点及预防方法。方法对2001年1月1日至2010年12月31日10年间在中山大学附属三院妇科手术中发生泌尿系损伤的9例病例的损伤高危因素、损伤情况、损伤后诊治及预后进行回顾性分析。结果 10年间妇科手术8672例,发生泌尿系损伤9例,发生率为0.10%,其中输尿管损伤6例,发生率0.07%,膀胱损伤3例,发生率0.03%。主要疾病为子宫腺肌症、子宫内膜异位症4例(44.4%),子宫肌瘤2例(22.2%),宫颈肌瘤1例(11.1%),晚期卵巢癌1例(11.1%),宫颈癌1例(11.1%)。9例中有盆腔粘连7例(77.8%),子宫增大(6～13周)7例(77.8%),盆腹腔手术史4例(44.4%),2例(22.2%)为新开展宫、腹腔镜手术时发生。发现损伤的时间,术中6例(66.7%),术后3例(33.3%),术后发现者均为输尿管损伤,症状出现于术后3～14天,包括腹胀、腰疼、低热、尿量减少、阴道流水等。结论盆腹腔的严重粘连、子宫增大、盆腹腔手术史是妇科手术中泌尿系损伤的易发因素,输尿管损伤在术中易漏诊,应重视泌尿系损伤的易发因素,术前术中积极防治以减少损伤。Objective To investigate the high risk factors, clinical characteristics and prevention methods of urinary tract injury during gynecologic surgeries. Methods Between January 2001 and December 2010, a total of 9 cases of urinary tract injuries occurred during gynecological surgeries in our institution. The high risk factors, conditions of injuries, clinical characteristics, therapeutic methods and prognosis were retrospectively analyzed. Results Nine cases of urinary tract injuries （0.10%） occurred among the to- tal 8672 cases of gynecologic surgery performed in recent 10 years, including 6 cases of ureteral injuries （0.07%）, 3 cases of bladder injuries （0.03%）. The main diseases of these 9 cases were as follows： adeno- myosis and endometriosis in 4 cases （44.4%）, uterine fibroids in 2 cases （22.2%）, cervical leiomyoma in I case （11.1%）, advanced ovarian cancer in 1 case （11.1%）, cervical cancer in one case （11.1%）. There were 7 cases （77.8%） with pelvic adhesions, 7 cases （77.8%） with enlarged uterus （6 to 13 weeks）, 4 cases （44.4%） with abdominal surgery history, 2 cases （22.2%） happened when the laparoscopic and hysteroscopic operatively were newly performed in our department. Six eases were found during the operations （66.7%）, the other 3 cases （33.3%） were observed when the abnormal symptoms appeared in 3 to 14 days postopera- tions, including abdominal distention, back pain, fever, decreased urine volume, and vagina seepage. Con- elusions The high risk factors of urinary tract injury in gynecologic surgeries are severe abdominal adhesions, uterus enlargement and abdominal surgery history. Ureteral injury is easy to be ignored. These high risk factors should be paid enough attentions to prevent the urinary tract injuries.

关 键 词：妇科手术 泌尿系统 损伤 

分 类 号：R713[医药卫生—妇产科学]