因良性病变行子宫切除术引起尿路损伤的危险因素  

Risk factors of urinary tract injury secondary to hysterectomy

作　　者：杨婷[1] 田思娟 赵娟[1] 裴美丽[1] 赵敏伊 王丽[1] 杨筱凤[1] YANG Ting;TIAN Si-juan;ZHAO Juan;PEI Mei-li;ZHAO Min-yi;WANG Li;YANG Xiao-feng(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院妇产科

出　　处：《现代泌尿外科杂志》2019年第11期910-913,共4页Journal of Modern Urology

基　　金：陕西省科学技术研究发展计划项目（No.2017SF-126）

摘　　要：目的明确因良性病变行子宫切除术时尿路损伤的危险因素。方法回顾了2014年1月至2018年12月在3个医疗中心因良性病变行子宫切除术的患者中发生尿路损伤的45例患者的病例资料。未损伤组选择相邻2个因良性病变进行子宫切除术且未发生尿路损伤的患者,共90例。Logistic回归使用单变量和多变量进行组间比较(其中35例膀胱损伤和7例输尿管损伤,另有3例同时存在膀胱和输尿管损伤)。结果膀胱损伤和既往剖宫产病史有关(OR=2.8,95%CI:1.76~5.1),与术者为普通妇科主治医生有关(OR=2.5,95%CI:1.3~5.1),以及与经腹全子宫切除术有关(OR=1.8,95%CI:1.07~3.5)。输尿管损伤更容易发生于腹腔镜下的全子宫切除术(OR=10.4,95%CI:2.3~46.8)和经腹全子宫切除术(OR=4.7,95%CI:1.4~15.6)。结论良性子宫切除术的膀胱损伤与既往有剖宫产史、经腹全子宫切除术和手术者是普通妇科主治医生有关;输尿管损伤与经腹全子宫切除术以及腹腔镜下全子宫切除术有关,且腹腔镜全子宫切除患者更容易发生。ObjectiveTo identify the risk factors of urinary tract injury secondary to hysterectomy due to benign lesions.MethodsA total of 45 cases who had urinary tract injury due to hysterectomy during Jan.2014 and Oct.2018 were collected from 3 centers,and 90 patients who had no urinary tract injury when undergoing hysterectomy were enrolled as the controls.Logistic regression was adopted to perform univariate and multivariate comparisons between the two groups.ResultsBladder injury was associated with a prior history of cesarean section(OR=2.8,95%CI:1.76-5.1),qualification of surgeons(OR=2.5,95%CI:1.3-5.1),and trans-abdominal hysterectomy(OR=1.8,95%CI:1.07-3.5).Ureteral injury was associated with laparoscopic-assisted hysterectomy(OR=10.4,95%CI:2.3-46.8)and trans-abdominal hysterectomy(OR=4.7,95%CI:1.4-15.6).ConclusionBladder injury secondary to hysterectomy is associated with a prior history of cesarean section,trans-abdominal hysterectomy and qualification of surgeons;ureteral injury is associated with laparoscopic-assisted total hysterectomy and trans-abdominal hysterectomy,and laparoscopic-assisted total hysterectomy is more likely to cause ureteral injury.

关 键 词：膀胱损伤 输尿管损伤 子宫切除 危险因素 

分 类 号：R693.5[医药卫生—泌尿科学]