48例医源性输尿管损伤临床处理及疗效观察  

Clinical Treatment and Efficacy of 48 Cases of Iatrogenic Ureteral Injury

作　　者：王亚申 罗飞[1] 李健[1] WANG Yashen;LUO Fei;LI Jian(Urinary Surgery,Tianjin People’s Hospital,Tianjin 300211,China)

机构地区：[1]天津市人民医院泌尿外科,天津300211

出　　处：《河南医学研究》2021年第32期6013-6016,共4页Henan Medical Research

摘　　要：目的探讨医源性输尿管损伤的临床处理方法及其疗效。方法回顾性分析2015年7月至2020年6月天津市人民医院48例医源性输尿管损伤患者的临床资料,其中泌尿外科手术5例,妇产科手术17例,肛肠外科手术26例。48例患者均为一期手术,术中诊断的16例患者,其中5例一期单纯行经尿道输尿管支架置入术,11例行输尿管端端吻合术+输尿管支架置入术;延迟诊断的32例患者,其中13例行输尿管支架置入术,12例行输尿管端端吻合术+输尿管支架置入术,2例行膀胱瓣输尿管下段成形术,4例行输尿管膀胱顶部再植术,1例患者行永久性肾造瘘术。结果 48例患者均一期手术成功,术后3个月拔出输尿管支架管,拔出输尿管支架后随访3~6个月,拔出输尿管支架后6个月行泌尿系彩超及静脉尿路造影(IVU)检查,36例输尿管无狭窄、肾盂积水消失,12例出现肾盂积水及不同程度输尿管狭窄。12例患者均二期手术干预,其中10例行输尿管端端吻合术,术后3个月复查泌尿系彩超及IVU检查,输尿管无狭窄、肾盂积水消失,2例行永久性肾造瘘术。结论医源性输尿管损伤患者早期发现和处理,恢复更快,远期并发症的发病率更低,输尿管预后更好。Objective To investigate the clinical treatment and efficacy of iatrogenic ureteral injury.Methods The clinical data of 48 patients with iatrogenic ureteral injury in Tianjin People’s Hospital from July 2015 to June 2020 were retrospectively analyzed,of which 5 cases of urology surgery,17 cases of obstetrics and gynecology,and 26 cases of anorectal surgeries.All the 48 patients underwent primary management,among which 16 patients were diagnosed intraoperatively,5 patients received primary ureteroscopic ureteral stent implantation,and ureteroureterostomy was performed over a ureteral stent for another 11 patients.Among the 32 patients with delayed diagnosis,13 patients received ureteral stent implantation,12 patients received ureteroureterostomy and ureteral stent implantation,2 patients received lower ureteroplasty with bladder flap,4 patients received ureterovesical reimplantation,and 1 patient received permanent nephrostomy.Results All the 48 patients were successfully operated in primary management,after followed up for 3-6 months,and 6 months after removal of ureteral stent patients received urological ultrasonography and intravenous urography(IVU) examination.Thirty-six patients had no ureteral stricture and hydronephrosis disappeared,and 12 patients were found to have late strictures and hydronephrosis.All the 12 patients underwent secondary surgical intervention.Among which 10 underwent ureteroureterostomy,and color ultrasound and IVU examination of urinary system were performed 3 months after the operation,no ureteral stricture and hydronephrosis disappeared.Permanent nephrostomy was performed in 2 patients.Conclusion Early detection and treatment of iatrogenic ureteral injury results in faster recovery,lower incidence of long-term complications and better ureteral prognosis.

关 键 词：输尿管损伤 输尿管端端吻合术 输尿管狭窄 

分 类 号：R693.5[医药卫生—泌尿科学]