Palmer L S, Rosenbaum R R, Gershbaum M D, Kreutzer E R
Department of Urology, Albert Einstein College of Medicine, Bronx, New York, USA.
Urology. 1999 Jul;54(1):34-6. doi: 10.1016/s0090-4295(99)00025-4.
To review the evaluation and management of patients with penetrating ureteral injuries not associated with iatrogenic etiology.
A retrospective analysis of 20 patients with penetrating ureteral injuries during a 10-year period at a Level 1 trauma center was performed. Data were collected regarding the mechanism of injury, initial urinalysis and radiographic studies, operative procedure, associated injuries, postoperative complications, and outcome.
In general, patients were young (mean age 27.8 years) men (95%). All injuries were unilateral (14 left and 6 right), were primarily caused by gunshot wounds (95%), and were associated with other injuries (100%). Three injuries were to the proximal ureter, 7 to the middle, and 10 to the distal ureter. Admission urinalysis failed to show gross or microscopic hematuria in 25% of cases. Preoperative intravenous urography (IVU) was diagnostic in 25% of cases. Fifteen injuries were diagnosed intraoperatively, including 2 with diagnostic IVU. Delayed diagnoses were made in 4 cases at 3 to 11 days; two by IVU postoperatively and the other two by computed tomography. All patients were treated surgically by ureteroneocystostomy, ureteroureterostomy, or pyeloplasty. Every repair was stented for a mean of 38 days (range 10 to 72). All three major complications (ureteral stricture, persistent urinary leak, and ureterocutaneous fistula) were managed successfully. Thirteen patients with long-term follow-up demonstrated no evidence of obstruction.
Ureteral injuries must be considered early during the evaluation of penetrating abdominal injuries. The admission urinalysis may be falsely normal and initial IVU may be nondiagnostic. The diagnosis may be made intraoperatively or be delayed. The surgical repair should be stented, and long-term success can be anticipated.
回顾非医源性病因所致穿透性输尿管损伤患者的评估与处理。
对一家一级创伤中心10年间20例穿透性输尿管损伤患者进行回顾性分析。收集有关损伤机制、初始尿液分析和影像学检查、手术方式、合并损伤、术后并发症及预后的数据。
总体而言，患者多为年轻男性（平均年龄27.8岁，95%为男性）。所有损伤均为单侧（左侧14例，右侧6例），主要由枪伤引起（95%），且均合并其他损伤（100%）。3例为近端输尿管损伤，7例为中段损伤，10例为远端输尿管损伤。25%的病例入院时尿液分析未显示肉眼或镜下血尿。术前静脉尿路造影（IVU）在25%的病例中具有诊断价值。15例损伤在术中确诊，其中2例通过诊断性IVU确诊。4例在术后3至11天出现延迟诊断；2例通过术后IVU诊断，另外2例通过计算机断层扫描诊断。所有患者均接受了输尿管膀胱吻合术、输尿管输尿管吻合术或肾盂成形术等手术治疗。每次修复均放置支架，平均时间为38天（范围10至72天）。所有三种主要并发症（输尿管狭窄、持续性尿漏和输尿管皮肤瘘）均得到成功处理。13例接受长期随访的患者未发现梗阻迹象。
在评估穿透性腹部损伤时，必须早期考虑输尿管损伤。入院时尿液分析可能结果正常但有假阴性，初始IVU可能无法确诊。诊断可在术中做出或延迟。手术修复应放置支架，有望获得长期成功。
