Mathevet P, Valencia P, Cousin C, Mellier G, Dargent D
Department of Gynecology, Hopital E. Herriot, Pavillon L., 69437 Lyon Cedex 03, France.
Eur J Obstet Gynecol Reprod Biol. 2001 Jul;97(1):71-5. doi: 10.1016/s0301-2115(00)00484-x.
To evaluate incidence, characteristics and consequences of urinary and intestinal tract injuries during vaginal hysterectomy for benign conditions.
From January 1970 to December 1996, 3076 vaginal hysterectomies with or without additional procedures, were performed for benign conditions in our department. We retrospectively analyzed operative injury cases.
Incidence of urinary and intestinal tract injuries were 1.7 and 0.5%, respectively. Concerning urinary tract injuries, we observed only one ureteral lesion, all others being bladder lacerations (54 cases). The bladder lacerations occured during the hysterectomy step of the surgery in 61% of cases and during the additional procedures in 39%. All bladder injuries were recognized and treated during the primary operation. We observed four cases of vesico-vaginal fistula as a consequence of these injuries; all fistulas occured after bladder laceration during the hysterectomy step of the surgical procedure. Intestinal tract injuries (16 cases) were rectal lacerations occuring during the hysterectomy step of the surgery (31% of cases) and during the additional procedures (69%). All rectal injuries were recognized and repaired during the primary operation and all healed without sequellae.
Operative injuries during vaginal hysterectomy are relatively rare. They are easily recognized and treated during the primary operation without important sequellae.
评估良性疾病行阴道子宫切除术中泌尿道和肠道损伤的发生率、特征及后果。
1970年1月至1996年12月，我科对良性疾病行3076例阴道子宫切除术，其中部分病例还进行了附加手术。我们对手术损伤病例进行了回顾性分析。
泌尿道和肠道损伤的发生率分别为1.7%和0.5%。关于泌尿道损伤，我们仅观察到1例输尿管损伤，其他均为膀胱撕裂伤（54例）。61%的膀胱撕裂伤发生在子宫切除步骤，39%发生在附加手术过程中。所有膀胱损伤均在初次手术中被发现并处理。我们观察到4例因这些损伤导致的膀胱阴道瘘；所有瘘均发生在手术子宫切除步骤中的膀胱撕裂伤后。肠道损伤（16例）为直肠撕裂伤，31%发生在子宫切除步骤，69%发生在附加手术过程中。所有直肠损伤均在初次手术中被发现并修复，且均愈合无后遗症。
阴道子宫切除术中的手术损伤相对少见。它们在初次手术中易于被发现和处理，且无严重后遗症。
