输尿管镜下输尿管会师术治疗医源性输尿管损伤的临床效果分析  

Analysis of Ureteral Realignment by Ureteroscope in the Cases of Iatrogenic Ureteral Injuries

作　　者：王晓男 王尧[2] 王伟华[2] 

机构地区：[1]吉林省长春市奋进医院外科,吉林长春130000 [2]吉林大学中日联谊医院泌尿外科,吉林长春130033

出　　处：《中国医药指南》2014年第13期35-35,37,共2页Guide of China Medicine

摘　　要：目的：探讨经皮输尿管镜技术在医源性输尿管损伤中的应用价值。方法2009年2月至2012年12月吉林大学中日联谊医院泌尿外科收治因腹腔镜手术导致输尿管部分或完全断裂患者12例，平均年龄41（23-52）岁，男性1例，女性11例；右侧9例，左侧3例；12例合并输尿管瘘，其中输尿管部分断裂8例，完全断裂4例。腹腔镜术后发现输尿管损伤中位之间6（2-18）d。4例尿瘘患者引流液或阴道溢出液测得肌酐平均值1567（425-2856）μmol/L。12例行经皮穿刺于近端输尿管内置入导丝，后行经尿道输尿管镜输尿管梗阻段内切开术，找到导丝并钳入远端输尿管，将输尿管断端拉近、会师，留置输尿管内支架管。术后复查超声、肾盂分泌造影并定期复查。结果12例手术均成功置入输尿管支架管。术中腹平片证实输尿管支架管位置良好，肾盂分泌造影显示积水减轻或消失，支架管保留8.2（6-36）周。平均随访时间352（42-912）d。结论熟练掌握经皮肾穿刺和输尿管镜技术的医师可以完成输尿管镜下输尿管会师术，对于医源性输尿管损伤的病例，这种治疗方式微创、有效，可以避免二次开放手术。Objective To discuss the value about ureteroscopy in the treatment of iatrogenic ureteral injury. Methods In this study, 12 cases of ureteral injury were caused by laparoscopic surgery, with average age being 41 （23 to 52）, including 1 male and 11 females, 9 injuied on right ureter, 3 on the other side. 12 cases mergerd ureter fistula, including 8 being partal fractuers, 4 completely broken. The diagnosis was delayed with a median time of 6（2 to 18）d. The mean measured creatinine of 4 vaginal and overlow drainages is 1567（425 to 2856） μmol/L. The guaidwire was placed in the proximal ureter by nephrostomy, Ureter incision was performed by ureteroscope. Godet being found was clamped into the distal ureter. When ureteral stent tube was placed in the ureter, the realignment was done. Ultrasound, KUB, IVP and long-term follow up were carried out after the operation. Result The ureteral stent tube was successfully placed in all the cases. All the stents were in position and retention time was 8.2（6 to 36） weeks. The mean fellow up time is 352（42 to 912）d. Conclusion The surgeon with master technique of percutaneous and ureteroscopy can complete ureter realignment operation. For cases of iatrogenic ureteral injuries, it is a simple and effective method, which can avoid open operation.

关 键 词：输尿管镜 医源性疾病 瘘 

分 类 号：R693[医药卫生—泌尿科学]